THE SYMPTOMS and signs of meningeal inflammation, which may result from either infectious or noninfectious processes (as listed in Table 1 ), are generally easily recognized. It is often difficult, however, to distinguish between specific varieties of meningeal infection even after careful clinical and laboratory evaluation. The difficulty is even greater if the infection has been inadequately treated in advance of proper diagnostic study. Antibiotics used in this fashion may alter the course of a meningeal infection without checking its eventual fatal termination.
In this review of the treatment of meningitis the important clinical features that aid in its diagnosis, the complications that may occur during treatment of the infection, and the specific therapies that have been used with the greatest success will be discussed.
General Clinical and Laboratory Features
Meningitis Due to Infection.—
The signs and symptoms of meningitis occur not only as a result of the meningeal inflammatory reaction, but also because of the local process from which invasion of the pia-arachnoid arises, the occasional focal or diffuse cerebral injury, and the systemic response to infection.