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Ms. J, a 19-year-old college student, has been living in a dormitory on campus. She began...

Ms. J, a 19-year-old college student, has been living in a dormitory on campus. She began experiencing severe headaches, neck pain, and nuchal rigidity, along with irritability and nausea. She noticed that when lying with her hips flexed, she found it very hard to stretch out her legs. Within a day her condition deteriorated, she experienced a tonic-clonic seizure, and she was quickly admitted to the hospital. Tests revealed increased intracranial pressure, fever, and leukocytosis. Bacterial meningitis was suspected, and a lumbar puncture was scheduled.

1.  Explain the rationale for each manifestation present at this stage. Which manifestation(s) is (are) most significant in the diagnosis of bacterial meningitis? Why are no focal signs present?

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  • Headache , irritation , seizures and nausea are because of increased intracranial pressure. Nuchal rigidity and meck pain are because of inflammed arachnoid and piamater whereas duramater is not inflammed but activated that contribute towards neck pain and rigidity.

positive kernig sign is because of meningeal irritation by movement of spinal cord .

Severe headache, nuchal rigidity and neck pain are specific manifestation of bacterial meningitis.

  • there are no focal signs as there are generalised symptoms of meningitis are present and no symptoms because of involvement of nerve, brain or spinal cord that control a specific function.
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