Although the primary clinical presentation is a systemic or pulmonary illness, which is unlikely to be solely or initially neurological [15] , all 3 forms of anthrax can be complicated by meningitis, mostly in the second stage of the disease [30] . The risk of hemorrhagic meningitis in cases of inhalational anthrax is estimated to be as high as 50% [18] . There was 20% of the known patients who developed meningitis after the mail-borne inhalational anthrax attack [29] . The most common neurological manifestations are headache and confusion [29] . In the closely studied cases in the U. S. in 2001, neurological abnormalities were noted in 80% [29] .