In adults, the most common symptom of meningitis is severe headaches, which occur in almost 90% of cases of bacterial meningitis, followed by neck stiffness (inability to move the neck forward due to increased neck muscle tone and stiffness). The classic triad of signs of meningitis is stiff necking, sudden high fever, and changes in mental status; however, all three of these features occur only in 44–46% of cases of bacterial meningitis. If none of these three symptoms can be said, it is not meningitis. Other features associated with meningitis include photophobia (intolerance to bright light) and phonophobia (intolerance to loud sounds). In young children, the symptoms mentioned above are often not visible, and can only be fussy and look unhealthy. Tufts (the soft part on the top of the baby's head) can stand out in babies up to 6 months old. Other characteristics that distinguish meningitis from other diseases that are not dangerous in children are leg pain, cold hands and abnormal skin color.
Stiff necking occurs in 70% of adult bacterial meningitis patients. Another sign of meningism is the positive "Kernig's sign" or "Brudziński sign". For the "Kernig's sign" examination the patient is lying on his back, with his pelvis and knees inflated to an angle of 90 degrees. In patients with positive "Kernig's sign," pain will passively limit knee extension. Positive "Brudzinski" sign when flexion in the neck causes involuntary flexion of the knee and pelvis. Although "Kernig's sign" and "Brudzinski's sign" are often used to make the diagnosis of meningitis, the sensitivity of both tests is limited, but both tests have good specificity for meningitis: this sign is rare in other diseases.Other tests, known as "jolt accentuation maneuver" help determine whether there is meningitis in patients who have complain of fever and headache, the person is asked to turn his head horizontally quickly, if the headache does not get worse, it is not meningitis.
Meningitis caused by the bacterium Neisseria meningitidis (known as "meningococcal meningitis") can be distinguished from other types of meningitis if the rash of the petechial rash spreads quickly, which can occur before other symptoms occur. This rash is in the form of small, large, irregular red or purple ("petechiae") spots on the body, lower limbs, mucous membranes, conjunctiva, and (sometimes) the palms and soles of the feet. The rash usually does not turn pale; the red color does not fade when pressed with a finger or glass rod. Although the rash does not always occur in meningococcal meningitis, it is quite specific for meningococcal meningitis; but rashes can sometimes also occur in meningitis caused by other bacteria. Another feature that can help determine the cause of meningitis is a sign on the skin caused by hand, foot and mouth disease and genital herpes, both of which are associated with several forms of viral meningitis.