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Having a headache and fever typically is no big deal. But when these two symptoms occur with a stiff neck or a change in mental status, it's a completely different story - sometimes with a scary ending.

"A headache, fever and stiff neck are the hallmark symptoms of meningitis, a serious infection of the membranes surrounding the brain," says Robert Colgrove, M.D., Attending Physician and Microbiology Instructor at Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School. "When these three symptoms occur together, people should seek emergency medical attention."

People should also seek immediate attention if they experience a headache and fever along with a change in mental status, such as confusion and hallucinations. This pattern of symptoms can indicate encephalitis, an inflammation of the brain itself.

Different types of meningitis
Bacterial meningitis is by far more serious than viral meningitis. It occurs when bacteria from another part of the body enters the bloodstream and migrates to the brain and spinal cord. Most cases of bacterial meningitis are caused by the types of bacteria that inhabit the upper respiratory tract.

If left untreated, bacterial meningitis can quickly lead to seizures and permanent neurological damage, including blindness, loss of speech or hearing, learning disabilities, paralysis or even death.

"Anytime a headache, fever and stiff neck occur at the same time, you should get an immediate diagnosis - preferably in the emergency room," Dr. Colgrove says. "You should not wait for symptoms to get better on their own."

In the emergency room, doctors will perform a spinal tap, a procedure in which they withdraw a small amount of fluid from the spinal cord. Doctors examine the fluid for bacteria. If they diagnose bacterial meningitis early enough, they usually can treat it successfully with intravenous antibiotics. In some cases, they may need to treat related conditions, such as brain swelling, shock, convulsions or dehydration.

Viral meningitis, which is more common and less severe, tends to resolve on its own after one or two weeks. Along with a severe headache and fever, symptoms often include a rash, sore throat and joint aches. Most cases of viral meningitis are caused by enteroviruses, which can also cause gastrointestinal infection, but a wide variety of other viruses can occasionally cause meningitis as well.

Doctors often treat viral meningitis with bed rest, plenty of fluids and over-the-counter pain medications to reduce fever and discomfort.

Understanding encephalitis
Encephalitis, an infection of the brain itself, can be caused by a viral infection that stems from a herpes virus; an arborvirus, which often is transmitted by mosquitoes and ticks; or rabies, a disease transmitted through animal bites. Children who have not been properly vaccinated may also contract viral infections from measles, mumps or rubella.

Most often, encephalitis is mild and causes only flu-like symptoms that go away on their own after a few days. Rest, acetaminophen, a healthy diet and plenty of fluids can help treat the symptoms.

Occasionally, encephalitis is severe. Symptoms of this form of the disease include headache, and fever and mental changes, such as confusion, hallucinations or personality changes. Seizures, brain swelling or other symptoms may accompany these symptoms. As with meningitis, doctors typically perform a spinal tap to analyze the fluid surrounding the brain and spinal cord. They may perform additional tests if seizures and brain swelling are involved.

Viral encephalitis doesn't respond to antibiotics. However, for encephalitis caused by Herpes Simplex Virus, which is the cause of cold sores, doctors treat it with anti-viral medications. They may also treat related brain swelling with anti-inflammatory drugs and seizures with anticonvulsant medications.

To avoid the infections that can lead to meningitis and encephalitis, it helps to practice a healthy lifestyle. This includes eating healthy foods, getting sufficient sleep and washing your hands regularly. Also make sure you and your children have recommended vaccinations and take precautions to avoid mosquito bites such as wearing appropriate clothing and using mosquito repellent.

For a free Mount Auburn Hospital physician directory, please call us at (617) 499-5094.