The classic signs of meningitis, such as the Brudzinski, Kernig and Babinski, are usually bilateral. When unilateral symptoms occur, one is often inclined to rule out the presence of meningitis and to think of brain abscess, brain tumor, encephalitis or poliomyelitis.
I have encountered cases that manifested unilateral Brudzinski, Kernig and Babinski signs, in which the character of the cerebrospinal fluid, and, in some instances, the necropsy, proved the presence of a meningitis, either tuberculous, pneumococcic or meningococcic. This shows that, although the classic signs of meningitis are usually bilateral, unilateral manifestations of meningeal irritation do not exclude the diagnosis of meningitis. This knowledge is particularly important in the diagnosis of meningococcic meningitis, in which reliance on unilateral symptoms to exclude meningitis may lead to delay in the removal of cerebrospinal fluid and the administration of serum with consequent disastrous results.
Unilateral manifestations during the course of meningitis may be
LEVINSON A. UNILATERAL SYMPTOMS IN MENINGITIS. JAMA. 1928;90(7):520-524. doi:10.1001/jama.1928.02690340022008