Assessment 

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.