Meningism
Encyclopedia
Meningism is the triad of nuchal rigidity (neck stiffness), photophobia
Photophobia
Photophobia is a symptom of abnormal intolerance to visual perception of light. As a medical symptom photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical photosensitivity of the eyes, though the term...

 (intolerance of bright light) and headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...

. It is a sign
Medical sign
A medical sign is an objective indication of some medical fact or characteristic that may be detected by a physician during a physical examination of a patient....

 of irritation of the meninges
Meninges
The meninges is the system of membranes which envelopes the central nervous system. The meninges consist of three layers: the dura mater, the arachnoid mater, and the pia mater. The primary function of the meninges and of the cerebrospinal fluid is to protect the central nervous system.-Dura...

, such as seen in meningitis
Meningitis
Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs...

, subarachnoid hemorrhage
Subarachnoid hemorrhage
A subarachnoid hemorrhage , or subarachnoid haemorrhage in British English, is bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain...

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. 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%.

Nuchal rigidity

Nuchal rigidity is the inability to flex the head
Head
In anatomy, the head of an animal is the rostral part that usually comprises the brain, eyes, ears, nose and mouth . Some very simple animals may not have a head, but many bilaterally symmetric forms do....

 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 Waldemar Kernig
Woldemar Kernig
Woldemar Kernig, better known as Vladimir Mikhailovich Kernig was a notable Russian and Baltic German internist and neurologist whose medical discoveries saved thousands of people with meningitis. He is best known for his pioneering work on diagnostics...

 (1840–1917), a Baltic German
Baltic German
The Baltic Germans were mostly ethnically German inhabitants of the eastern shore of the Baltic Sea, which today form the countries of Estonia and Latvia. The Baltic German population never made up more than 10% of the total. They formed the social, commercial, political and cultural élite in...

 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). This may indicate subarachnoid haemorrhage or meningitis. Patients may also show opisthotonus
Opisthotonus
Opisthotonus or opisthotonos, from Greek roots, opistho meaning "behind" and tonos meaning "tension", is a state of a severe hyperextension and spasticity in which an individual's head, neck and spinal column enter into a complete "bridging" or "arching" position...

—spasm of the whole body that leads to legs and head being bent back and body bowed backwards.

Brudzinski's signs

Jozef Brudzinski
Józef Brudzinski
Józef Polikarp Brudziński was a Polish pediatrician who was born in the village of Bolewo .He studied medicine in Tartu and Moscow, and in 1897 moved to Krakow, where he trained in pediatrics...

 (1874–1917), a Polish
Poles
thumb|right|180px|The state flag of [[Poland]] as used by Polish government and diplomatic authoritiesThe Polish people, or Poles , are a nation indigenous to Poland. They are united by the Polish language, which belongs to the historical Lechitic subgroup of West Slavic languages of Central Europe...

 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
Supine position
The supine position is a position of the body: lying down with the face up, as opposed to the prone position, which is face down, sometimes with the hands behind the head or neck. When used in surgical procedures, it allows access to the peritoneal, thoracic and pericardial regions; as well as the...

.

Other signs attributed to Brudzinski:
  • The symphyseal sign, in which pressure on the pubic symphysis
    Pubic symphysis
    The pubic symphysis or symphysis pubis is the midline cartilaginous joint uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis...

     leads to abduction of the leg and reflexive hip and knee flexion.
  • The cheek sign, in which pressure on the cheek below the zygoma
    Zygoma
    The term zygoma generally refers to the zygomatic bone, a bone of the human skull commonly referred to as the cheekbone or malar bone, but it may also refer to:...

    leads to rising and flexion in the forearm.
  • 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.

External links

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