4. The vision is very frequently affected due to the choked disk that is present.
5. Temperature, pulse, and respiration are very frequently disturbed.
6. Definite focal symptoms of brain localization are of the utmost importance in the diagnosis.
7. Blood and spinal fluid examinations give very valuable information.
8. Röntgenographic findings are at times valuable.
9. Exploratory operation and treatment, as in lues, is at times necessary to make a diagnosis.
MENINGITIS
(a) Serous meningitis.—One of the first signs is the increasing headache, at first localized, usually near the seat of the perforation or path of infection, and soon becoming diffuse over the head. The patient loses his appetite, his tongue becomes coated, the emunctaries become sluggish in their action, and nausea is a very common symptom. The temperature rises, and, if the septic form is going to follow, this rise is often quite rapid, so that there may occur small chills from the infection of the cerebrospinal fluid. The pulse and respiration rate is now considerably increased. The patient is very irritable and restless, and does not sleep. As soon as the fluid increases within the cavity there is observed the characteristic syndrome of rolling the eyes, especially upward, the neck is drawn backwards, and finally the leg upon the thigh and thigh upon the abdomen. Attempts to straighten them out is resisted and appears to be painful,—Kernig’s sign.
Stroking the bottom of the feet with some semisharp instrument or the finger-nail will cause the big toe to turn up instead of down,—Babinski’s sign.
Taking the head and tilting it forward against the chest will cause the limbs to be drawn up,—Brudzinski’s sign.