Disorders of the Neurological System Practice Test 2026 - Free Neurological Disorders Practice Questions and Study Guide

Bacterial meningitis presents with a rapid onset of systemic and meningeal symptoms, reflecting inflammation of the meninges and increased intracranial pressure. Clinically, this includes fever, severe headache, photophobia, nausea and vomiting, irritability or restlessness, and often a decreased level of consciousness. Neck stiffness is a classic sign, and many patients have positive Brudzinski and Kernig signs, which reflect meningeal irritation.

A key clue is the appearance of a purpuric or petechial rash, especially with meningococcal infection, signaling possible disseminated disease. Alongside these signs, there is usually leukocytosis in the blood.

The cerebrospinal fluid (CSF) profile is characteristic: a high white blood cell count with neutrophil predominance, elevated protein, and low glucose. Blood cultures or CSF Gram stain/culture can identify the organism. These findings help distinguish bacterial meningitis from viral meningitis, where CSF leukocytes are typically lymphocytes and glucose may be normal.

Thus, the combination of acute meningeal symptoms with fever, plus the CSF pattern of high WBC, high protein, and low glucose (often with possible bacteria seen on Gram stain or culture), best fits bacterial meningitis.