Meningism

Meningism
Classification and external resources
ICD-10	R29.1
ICD-9	781.6
MeSH	D008580

Meningism is the triad of nuchal rigidity (neck stiffness), photophobia (intolerance of bright light) and headache. It is a sign of irritation of the meninges, such as seen in meningitis, subarachnoid hemorrhages and various other diseases. "Meningismus" is the term used when the above listed symptoms are present without actual infection or inflammation; usually it is seen in concordance with other acute illnesses in the pediatric population.^[1] Related clinical signs include Kernig's sign and three signs all named Brudzinski's sign.

Clinical signs

The main clinical signs that indicate meningism are nuchal rigidity, Kernig's sign and Brudzinski's signs. None of the signs are particularly sensitive; in adults with meningitis, nuchal rigidity was present in 30% and Kernig's or Brudzinski's sign only in 5%.^[2]

Nuchal rigidity

Nuchal rigidity is the inability to flex the head forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent.^{[citation needed]}

Kernig's sign

Kernig's sign (after Waldemar Kernig (1840–1917), a Baltic German neurologist) is positive when the leg is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance).^[3] This may indicate subarachnoid haemorrhage or meningitis.^[4] Patients may also show opisthotonus—spasm of the whole body that leads to legs and head being bent back and body bowed backwards.^{[citation needed]}

Brudzinski's signs

Jozef Brudzinski (1874–1917), a Polish pediatrician, is credited with several signs in meningitis. The most commonly used sign (Brudzinski's neck sign) is the appearance of involuntary lifting of the legs in meningeal irritation when lifting a patient's head off the examining couch, with the patient lying supine.^[2][5]

Other signs attributed to Brudzinski:^[6]

• The symphyseal sign, in which pressure on the pubic symphysis leads to abduction of the leg and reflexive hip and knee flexion.^[7]
• The cheek sign, in which pressure on the cheek below the zygoma leads to rising and flexion in the forearm.^[7]
• Brudzinski's reflex, in which passive flexion of one knee into the abdomen leads to involuntary flexion in the opposite leg, and stretching of a limb that was flexed leads to contralateral extension.^[8]

See also

• Meningitis

References

1. ^ ICD9Data.com - Diagnosis Codes, Meningismus
2. ^ ^{a b} Thomas KE, Hasbun R, Jekel J, Quagliarello VJ (2002). "The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis". Clin. Infect. Dis. 35 (1): 46–52. doi:10.1086/340979. PMID 12060874. http://www.journals.uchicago.edu/doi/full/10.1086/340979. 
3. ^ Kernig VM (1882). "Ein Krankheitssymptom der acuten Meningitis". St Petersb Med Wochensch 7: 398. 
4. ^ O'Connor, Simon; Talley, Nicholas Joseph (2001). Clinical Examination: A Systematic Guide to Physical Diagnosis. Cambridge, MA: Blackwell Publishers. p. 363. ISBN 0-632-05971-0. 
5. ^ Brudzinski J (1909). "Un signe nouveau sur les membres inférieurs dans les méningites chez les enfants (signe de la nuque)". Arch Med Enf 12: 745–52. 
6. ^ doctor/2299 at Who Named It?
7. ^ ^{a b} Brudzinski J (1916). "Über neue Symptome von Gehirnhautentzündung und -reizung bei Kindern, insbesondere bei tuberkulösen". Berl Klin Wochensch 53: 686–90. 
8. ^ Brudzinski J (1908). "Über die kontralateralen Reflexe an den unteren Extremitäten bei Kindern". Wien Klin Wochensch 8: 255–61. 

External links

• FPnotebook page on meningeal signs
• Image of Kernig's sign