Clinical Manifestations of Viral Meningitis

History
• Most patients reported fever, headache, iritabilitasm nausea, vomiting, stiff neck, or fatigue within 18-36 hours earlier.

• Headache is almost always there and often reported with severe intensity.

• other constitutional symptoms are vomiting, diarrhea, cough and myalgia that arise in 50% of patients.

• History of the temperature rise occurs in 76-100% of patients who come to get medical perjatian. Frequent patterns with low-grade fever in the prodromal phase and the higher temperature rise when there are neurological signs.

• Some viruses cause rapid onset of the symptoms, while others manifest as nonspecific viral prodrome, such as myalgia, flu-like symptoms, low-grade fever and neurological symptoms arising during about 48 hours. With the onset of a stiff neck and headache, fever is usually returned.

• Taking a careful history, and should include evaluation of pain contact exposure, mosquito bites, dust, outdoor activities in endemic areas of Lyme disease, a history of traveling to the possibility of exposure to tuberculosis, as well as the use of medications, intravenous drug use, and the risk of spreading sexually transmitted diseases.

• An important part of the history is prior antibiotic use, which can affect the clinical features of bacterial meningitis.

Physical
• The discovery of general physical in viral meningitis are the same for all agents and are often the cause, but some viruses have unique clinical manifestations that can help a focused diagnostic approach. Learning that teaches classical triad of meningitis include fever, nuchal rigidity, and altered mental status, although not all patients have these symptoms, and headache almost always arise. Examination revealed no focal neurological deficits in most cases.

• Fever more frequently (80-100% cases) and typically varies between 38 º C and 40 º C.

• nuchal rigidity or other signs of meningeal irritation (Kernig or Brudzinski's sign) may be seen more in half the patients but is generally less severe than bacterial meningitis.

• irritability, disorientation, and mental status changes can be seen.

• Headache is more frequent and severe.

• photophobia are relatively frequent but can be light, phonophobia may also arise.

• Seizures usually occur in circumstances of fever, although the involvement of the parenchyma of the brain (encephalitis) are also taken into account, global encephalopathy and focal neurologic deficits are rare but can occur. Deep tendon reflexes are usually normal but can be severe.

• Another sign of a specific viral infection can help in the diagnosis. This includes pharyngitis and pleurodynia on enteroviral infections, skin manifestations in VZV as zoster eruptions, maculopapular rash of measles, and enterovirus, herpes simplex by vesicular eruption, and herpangina coxsackie virus infection. Epstein Bar virus infection is supported by pharyngitis, lymphadenopathy, cytomegalovirus, or HLV as the agent causes. Parotitis and orchitis may occur with measles, while most enteroviral infections associated with gastroenteritis and rash.