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Answers on p 800. A 31 year old man was admitted after a 24 hour febrile illness with headache and confusion. On examination he was unwell, pyrexial at 39.4oC, tachycardic, and uncooperative. He became increasingly confused and agitated and exhibited signs of meningism. …

Summary We report here, we believe for the first time, the primary antiphospholipid syndrome, presenting with fever, meningismus and skin rash. Serology was positive for antiphospholipid antibodies but negative for antinuclear factor. Such presentations, once meningitis has been excluded, should be screened for antiphospholipid antibodies. If serology proves to be positive, anticoagulation for life should be considered to avoid thrombotic episodes and death due to pulmonary embolism.

A 52-year-old diabetic Indian man presented with a 2-week history of headache and fever. He had no evidence of meningism. There was mild polymorph leucocytosis and raised erythrocyte sedimentation rate of 113 mm/h. Other investigations, including tests for human immunodeficiency virus and immunoglobulins, yielded negative or normal results. Initial skull X-ray and brain …

Summary The results found and the laboratory methods used for the isolation of viruses and β haemolytic streptococci in two MRC/PHLS surveys of respiratory disease in patients in hospital and general practice are described. 717 viruses and 82 β haemolytic streptococci were isolated from 2418 children in hospital and 835 viruses and 435 strains of β haemolytic streptococci from patients seen in general practice. Virus isolation rates in the two surveys were 28·9% and 21·0% respectively. Rates by age, sex, time and by clinical categories are given and discussed in relation to isolations from control subjects, the cause of deaths in twenty-two of the children tested, and the incidence of convulsions and meningism found in those examined in these surveys.

Summary Thirty six patients were admitted to hospital as a result of Salmonella virchow infection during an outbreak of food poisoning in Essex in 1984. Out of 12 patients with evidence of bloodstream invasion, one third presented primarily with meningism and attention is drawn to this unusual clinical picture.

Summary A case of spinal subarachnoid haemorrhage with progressive spinal cord compression and without any evidence of meningism is described. Spinal block was demonstrated by myelography and computerized tomography and surgical decompression of the subarachnoid blood clot resulted in almost complete recovery. A diagnosis of spinal subarachnoid haemorrhage should be considered in any patient who presents with acute back pain and slowly or rapidly progressive neurological signs in the limbs, even when meningism is absent.