For assessment of clinical manifestation of the disease you need to understand three stages of clinical course of the disease which are as follows:
Prodromal Stage or Stage of Invasion
In this stage the child presents with vague symptoms like apathy or irritability, drowsiness, mild fever, convulsions, anorexia, vomiting, constipation and headache and younger child may strike his head with forearm. Child has photophobia, growth is stunted and child losses weight.
Stage of Meningitis (Transitional stage)
During this stage child presents with manifestation of raised intracrainal tension and irritation. Child may become progressively drowsy and even unconscious. Neck rigidity and kerning's sign is positive. The fever gets elevated and may be remittent and intermittent. Pulse is slow but is usually irregular in rhythm and volume. The breathing may be disturbed with sighing, yawning or hiccup. There may be increased muscle tone (hypertonia) and hyperaesthesia may be present and seizures may occur. Anterior fontanel may bulge in infants.