Meningism 1351993 226162463 2008-07-17T02:46:52Z WikiDreamer Bot 7221255 robot Modifying: [[fr:Signe de Kernig]] {{DiseaseDisorder infobox | Name = Meningism | ICD10 = {{ICD10|R|29|1|r|25}} | ICD9 = {{ICD9|781.6}} | }} '''Meningism''' is the triad of nuchal rigidity, [[photophobia]] (intolerance of bright light) and [[headache]]. It is a [[medical sign|sign]] of irritation of the [[meninges]], such as seen in [[meningitis]], [[subarachnoid hemorrhage]]s 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. <ref>[http://www.icd9data.com/2007/Volume1/780-799/780-789/781/781.6.htm ICD9Data.com] - Diagnosis Codes, Meningismus</ref> 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 ''Brudzinsky's signs''. None of the signs are particularly sensitive; in adults with meningitis, nuchal rigidity was present in 30% and Kernig's or Brudzinsky's sign only in 5%.<ref name=Thomas>{{cite journal |author=Thomas KE, Hasbun R, Jekel J, Quagliarello VJ |title=The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis |journal=Clin. Infect. Dis. |volume=35 |issue=1 |pages=46–52 |year=2002 |pmid=12060874 |url=http://www.journals.uchicago.edu/doi/full/10.1086/340979 |doi=10.1086/340979}}</ref> ===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. ===Kernig's sign=== Kernig's sign (after [[Woldemar Kernig]] (1840-1917), a [[Baltic German]] neurologist) is positive when the leg is fully bent in the hip and knee, and subsequent extension in the knee is painful (leading to resistance).<ref>{{cite journal | author=Kernig VM | year=1882 | title=Ein Krankheitssymptom der acuten Meningitis | journal=St Petersb Med Wochensch | volume=7 | pages=398}}</ref>. This may indicate subarachnoid haemorrhage or meningitis.<ref>{{cite book |author=O'Connor, Simon; Talley, Nicholas Joseph |title=Clinical Examination: A Systematic Guide to Physical Diagnosis |publisher=Blackwell Publishers |location=Cambridge, MA |year=2001 |pages= |isbn=0-632-05971-0 | pages=p 363}}</ref>. Patients may also show [[opisthotonus]]—spasm of the whole body that leads to legs and head being bent back and body bowed forward.{{fact|date=May 2008}} ===Brudzinski's signs=== Josef Brudzinski (1874-1917), a [[Poles|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.<ref>{{cite journal | author=Brudzinski J | year=1909 | title=Un signe nouveau sur les membres inférieurs dans les méningites chez les enfants (signe de la nuque) | journal=Arch Med Enf | volume=12 | pages=745–52}}</ref><ref name=Thomas/> Other signs attributed to Brudzinski:<ref>{{WhoNamedIt|doctor|2299}}</ref> * The symphyseal sign, in which pressure on the [[pubic symphysis]] leads to abduction of the leg and reflexive hip and knee flexion.<ref name=Brudzinski1916>{{cite journal | author=Brudzinski J | year=1916 | title=Über neue Symptome von Gehirnhautentzündung und -reizung bei Kindern, insbesondere bei tuberkulösen | journal=Berl Klin Wochensch | volume=53 | pages=686–90}}</ref> * The cheek sign, in which pressure on the cheek below the [[zygoma]] leads to rising and flexion in the forearm.<ref name=Brudzinski1916/> * 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.<ref>{{cite journal | author=Brudzinsky J | year=1908 | title=Über die kontralateralen Reflexe an den unteren Extremitäten bei Kindern | journal=Wien Klin Wochensch | volume=8 | pages=255–61}}</ref> ==See also== * [[Meningitis]] ==References== <references/> ==External links== * [http://www.fpnotebook.com/NEU97.htm FPnotebook page on meningeal signs] {{Nervous and musculoskeletal system symptoms and signs}} [[Category:Medical signs]] [[de:Meningismus]] [[fr:Signe de Kernig]] [[nl:Teken van Brudzinski]] [[ja:髄膜刺激症状]] [[pt:Meningismo]]