Meningism
Meningism | |
---|---|
Other names | Meningismus,[1][2] pseudomeningitis[1][3] |
Positive Kernig's sign in cerebrospinal meningitis | |
Differential diagnosis | Meningitis |
Meningism is a set of
Although nosologic coding systems, such as ICD-10 and MeSH, define meningism/meningismus as meningitis-like but in fact not meningitis, many physicians use the term meningism in a loose sense clinically to refer to any meningitis-like set of symptoms before the cause is definitively known. In this sense, the word implies "suspected meningitis". The words meningeal symptoms can be used instead to avoid ambiguity, thus reserving the term meningism for its strict sense.
Signs and symptoms
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%.[5]
Nuchal rigidity
Nuchal rigidity is the inability to flex the neck 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 Russian neurologist) is positive when the thigh is flexed at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance).[6] This may indicate subarachnoid hemorrhage or meningitis.[7] Patients may also show opisthotonus—spasm of the whole body that leads to legs and head being bent back and body bowed forward.[citation needed]
Brudzinski's signs
Other signs attributed to Brudzinski:[9]
- The symphyseal sign, in which pressure on the pubic symphysis leads to abduction of the leg and reflexive hip and knee flexion.[10]
- The cheek sign, in which pressure on the cheek below the zygoma leads to rising and flexion in the forearm.[10]
- 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.[11]
See also
References
- ^ a b c d Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier.
- ^ a b c Merriam-Webster, Merriam-Webster's Medical Dictionary, Merriam-Webster.
- ^ a b Wolters Kluwer, Stedman's Medical Dictionary, Wolters Kluwer.
- ^ National Library of Medicine, Meningism [MeSH Descriptor Data 2018], retrieved 2018-06-21.
- ^ PMID 12060874.
- ^ Kernig VM (1882). "Ein Krankheitssymptom der acuten Meningitis". St Petersb Med Wochensch. 7: 398.
- ISBN 0-632-05971-0.
- ^ 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.
- Who Named It?
- ^ a b Brudzinski J (1916). "Über neue Symptome von Gehirnhautentzündung und -reizung bei Kindern, insbesondere bei tuberkulösen". Berl Klin Wochensch. 53: 686–90.
- ^ Brudzinski J (1908). "Über die kontralateralen Reflexe an den unteren Extremitäten bei Kindern". Wien. Klin. Wochenschr. 8: 255–61.