Meningism is a set of symptoms similar to those of

meningitis Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or ...

but not caused by meningitis. Whereas meningitis is inflammation of the

meninges In anatomy, the meninges (, ''singular:'' meninx ( or ), ) are the three membranes that envelop the brain and spinal cord. In mammals, the meninges are the dura mater, the arachnoid mater, and the pia mater. Cerebrospinal fluid is located in ...

(membranes that cover the central nervous system), meningism is caused by nonmeningitic irritation of the meninges, usually associated with acute

febrile Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using va ...

illness, especially in children and adolescents. Meningism involves the triad (3-symptom syndrome) of nuchal rigidity (

neck stiffness Neck stiffness, stiff neck and nuchal rigidity are terms often used interchangeably to describe the medical condition when one experiences discomfort or pain when trying to turn, move, or flex the neck. Possible causes include muscle strain or spr ...

photophobia Photophobia is a medical 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 ...

(intolerance of bright light) and headache. It therefore requires differentiating from other CNS problems with similar symptoms, including meningitis and some types of intracranial hemorrhage. Related clinical signs include

Kernig's sign Kernig's sign is a test used in physical examination to look for evidence of irritation of the meninges. The test involves flexing the thighs at the hip, and the knees, at 90 degree angles, and assessing whether subsequent extension of the knee i ...

and three signs all named Brudzinski's sign. 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%.

Nuchal rigidity

Nuchal rigidity is the inability to flex the

neck The neck is the part of the body on many vertebrates that connects the head with the torso. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In ...

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 (1840–1917), a

Russia Russia (, , ), or the Russian Federation, is a transcontinental country spanning Eastern Europe and Northern Asia. It is the largest country in the world, with its internationally recognised territory covering , and encompassing one-eight ...

n 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). This may indicate subarachnoid hemorrhage or meningitis. Patients may also show

opisthotonus Opisthotonus or opisthotonos (from grc, ὄπισθεν, translit=opisthen, lit=behind and grc, τόνος, translit=tonos, lit=tension, label=none) is a state of severe hyperextension and spasticity in which an individual's head, neck and spinal ...

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

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 positive when the forced

flexion Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...

of the neck elicits a reflex flexion of the hips, with the patient lying

supine In grammar, a supine is a form of verbal noun used in some languages. The term is most often used for Latin, where it is one of the four principal parts of a verb. The word refers to a position of lying on one's back (as opposed to 'prone' ...

. Other signs attributed to Brudzinski: * The symphyseal sign, in which pressure on the

pubic symphysis The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubic ...

leads to abduction of the leg and reflexive hip and knee flexion. * The cheek sign, in which pressure on the cheek below the

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: * The zygomatic arch, a structure in the human skull formed primarily by parts of the ...

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.

References

External links