Difficult meningitis scenarios were reviewed. The best resource to read is Harrisons textbook of internal medicine.

Acute meningitis presentations – bacterial, viral and encephalitis vs

subacute presentations of bacterial brain abscess

Viral meningitis does not cause somnolence / drowsiness
Bacterial meningitis progresses to confusion
Encephalitis often presents with bizarre behaviour

Meningism, kernigs and neck stiffness are late signs and only present in <20% of adults and fewer children. mortality once meningism is present is 20-30% — so don’t use this to rule out meningitis!!!

Best resource for difficult types of meningitis eg TB, cryptococcal, syphillis is Nelsons textbook of paediarics or UTD.

see tables attached below