Which of the following are characteristics of generalized tonic-clonic seizures?

Choice A rationale

Photophobia, or an extreme sensitivity to light, is a common symptom in meningitis, resulting from the meningeal irritation and inflammation caused by the bacterial infection. The meninges, the protective layers covering the brain and spinal cord, contain pain-sensitive fibers. When inflammation reaches the optic nerve pathways or specific cranial nerves, light perception becomes a painful stimulus.

Choice B rationale

A petechial or purpuric rash is a critical and potentially ominous finding, especially in meningococcemia (caused by Neisseria meningitidis). The rash is caused by endothelial damage and vasculitis as the bacteria and inflammatory mediators enter the bloodstream, leading to small, non-blanching hemorrhages beneath the skin due to capillary leakage and microthrombi formation.

Choice C rationale

Nuchal rigidity (stiffness of the neck), a classic sign, is caused by inflammation of the meninges surrounding the cervical spinal cord. Attempting to flex the neck stretches the irritated meninges, eliciting pain and muscle spasm. This rigidity is often assessed using maneuvers like Brudzinski's or Kernig's signs, indicating meningeal irritation.

Choice D rationale

A high-pitched cry is more commonly associated with increased intracranial pressure (ICP), which can be a complication of severe meningitis, particularly in infants due to hydrocephalus or cerebral edema. While a sign of neurological distress, it is a less direct or specific initial symptom compared to the direct signs of meningeal irritation or systemic infection.

Choice E rationale

Seizures are a frequent complication, particularly in infants and young children with bacterial meningitis. They result from the direct inflammatory irritation of the cerebral cortex by the infectious process, cerebral edema, or vascular changes (e.g., thrombosis, infarcts) associated with severe intracranial infection, causing abnormal electrical activity.

Choice A rationale

Restricting fluids is generally contraindicated in meningitis unless there is documented syndrome of inappropriate antidiuretic hormone (SIADH) or severe, life-threatening cerebral edema. Maintaining adequate hydration is crucial to prevent dehydration and support systemic circulation, especially since fever can increase fluid loss.

Choice B rationale

Monitoring for signs of increased intracranial pressure (ICP) is paramount because meningeal inflammation can lead to cerebral edema and impaired CSF reabsorption. Signs like changes in level of consciousness, bradycardia, and hypertension (Cushing's triad) require immediate intervention to prevent brain herniation.

Choice C rationale

Administering acetaminophen (or ibuprofen) is appropriate for controlling the systemic symptoms of fever (pyrexia) and managing headache/body pain associated with meningeal irritation. Effective fever control reduces metabolic demands and can decrease the risk of febrile seizures.

Choice D rationale

Administering IV antibiotics immediately is the standard for bacterial meningitis to prevent morbidity and mortality, but viral meningitis is typically self-limiting and managed with supportive care; thus, empirical antibiotics are not indicated if the viral etiology is confirmed or highly suspected.

Choice E rationale

Encouraging rest and hydration is the cornerstone of supportive care for viral meningitis. Rest reduces cerebral metabolic demand and prevents overexertion, while hydration helps combat fluid losses from fever and vomiting and supports overall recovery.

Choice F rationale

Providing a quiet, dimly lit environment helps reduce noxious stimuli that can exacerbate common symptoms like headache and photophobia (light sensitivity), which are caused by meningeal inflammation and irritation of cranial nerves, thus promoting comfort and rest.