Meningism

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Meningism
Classification and external resources
ICD-10 R29.1
ICD-9-CM 781.6
DiseasesDB 29490
MeSH D008580

Meningism, also called meningismus[1][2] is a set of symptoms caused by irritation of the meninges. This may be due to meningitis (inflammation of the meninges), or subarachnoid haemorrhage. Meningism involves the triad (3-symptom syndrome) of nuchal rigidity (neck stiffness), photophobia (intolerance of bright light), and headache. It requires differentiating from other problems with similar symptoms, including Parkinson's Disease and Cervical Spondylosis . Related clinical signs include Kernig's sign and three signs all named Brudzinski's sign.

Signs and symptoms[edit]

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%.[3]

Nuchal rigidity[edit]

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[edit]

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).[4] This may indicate subarachnoid hemorrhage or meningitis.[5] 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[edit]

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 when lifting a patient's head off the examining couch, with the patient lying supine.[3][6]

Other signs attributed to Brudzinski:[7]

  • The symphyseal sign, in which pressure on the pubic symphysis leads to abduction of the leg and reflexive hip and knee flexion.[8]
  • The cheek sign, in which pressure on the cheek below the zygoma leads to rising and flexion in the forearm.[8]
  • 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.[9]

See also[edit]

References[edit]

  1. ^ Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier. 
  2. ^ Merriam-Webster, Merriam-Webster's Medical Dictionary, Merriam-Webster. 
  3. ^ 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. 
  4. ^ Kernig VM (1882). "Ein Krankheitssymptom der acuten Meningitis". St Petersb Med Wochensch. 7: 398. 
  5. ^ 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. 
  6. ^ 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. 
  7. ^ doctor/2299 at Who Named It?
  8. ^ a b Brudzinski J (1916). "Über neue Symptome von Gehirnhautentzündung und -reizung bei Kindern, insbesondere bei tuberkulösen". Berl Klin Wochensch. 53: 686–90. 
  9. ^ Brudzinski J (1908). "Über die kontralateralen Reflexe an den unteren Extremitäten bei Kindern". Wien Klin Wochensch. 8: 255–61. 

External links[edit]