SAL KHAN: We're here at StanfordMedical School with fourth year medical student Morgan Theisand Charles Prober. MORGAN THEIS: OK, Prober, what are we going to talk about todayé DR. CHARLES PROBER:So Morgan, I thought we'd talk about bacterialmeningitis in children. MORGAN THEIS: OK.
DR. CHARLES PROBER:And what I'd like to do, in reflectingon bacterial meningitis is go back to some lessonsthat we learned in quot;The Prudent Prescribing ofAntibiotics,quot; a prior tutorial. And one of the thingsthat was mentioned as a general principlein that particular tutorial was trying to understandwhere the site of infection is in a child, in order topick the right antibiotics
and the right management. So in this case,because I'm referring to bacterial meningitis,a question might be, what would make you think that achild has bacterial meningitisé That is, what are thesigns and symptoms of bacterial meningitisé MORGAN THEIS: So this is kindof thinking about the site, knowing thatthere's an infection
in the cerebrospinalfluid or fluid around the brainand spinal cord. You have to look for that in avariety of ways, as a . DR. CHARLES PROBER: Exactly. And one of the things whichwill make a physician suspicious that there may be an infectionin the cerebrospinal fluid or that is, in thecentral nervous system is, a child may notbe behaving normally.
That is, they'll have analtered state of consciousness. They'll be very, very sleepy. Or they'll be very irritable. MORGAN THEIS: OK, soI guess I would say, the signs hereirritable children. And what was theother one you saidé DR. CHARLES PROBER:And I mentioned they might be very sleepy.
Some people might usethe word lethargic, as an altered stateof consciousness. And at the extreme of that,the child would be in a coma. But that would be moreadvanced in the infection. And then, the childwould almost invariably have a fever associatedwith it, with this illness. And on examination, when thephysician examines the child, they may detect what arecalled meningeal signs.