Prodromal illness for 1–2 days

Fever

Purpuric/petechial rash (especially meningococcal infection)

Signs of meningeal irritation: headache, neck stiffness, vomiting, photophobia

Reduced conscious level

Seizures

Cranial nerve palsies

Focal neurological signs (if bacterial meningitis is complicated by cerebral venous sinus thrombosis or arteritis)

General examination may show signs of predisposing disorders:

• Ear infection
• Sinusitis
• Pneumonia