Meningism is a set of

symptom Signs and symptoms are diagnostic indications of an illness, injury, or condition. Signs are objective and externally observable; symptoms are a person's reported subjective experiences. A sign for example may be a higher or lower temperature ...

s 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, intense headache, vomiting and neck stiffness and occasion ...

but not caused by meningitis. Whereas meningitis is

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

of the

meninges In anatomy, the meninges (; meninx ; ) 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 the subarachnoid spac ...

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

febrile Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with body temperature exceeding the normal range caused by an increase in the body's temperature set point in the hypothalamus. There is no single agre ...

illness, especially in children and adolescents. Meningism involves the triad (3-symptom

syndrome A syndrome is a set of medical signs and symptoms which are correlated with each other and often associated with a particular disease or disorder. The word derives from the Greek language, Greek σύνδρομον, meaning "concurrence". When a sy ...

) 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 sp ...

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 o ...

(intolerance of bright light) and

headache A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of Depression (mood), depression in those with severe ...

. It therefore requires differentiating from other CNS problems with similar symptoms, including meningitis and some types of

intracranial hemorrhage Intracranial hemorrhage (ICH) refers to any form of Hemorrhage, bleeding Internal bleeding, within the Human skull, skull. It can result from trauma, vascular abnormalities, hypertension, or other medical conditions. ICH is broadly categorized ...

. Related clinical signs include Kernig's sign 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 in many vertebrates that connects the head to the torso. It supports the weight of the head and protects the nerves that transmit sensory and motor information between the brain and the rest of the body. Addition ...

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 country spanning Eastern Europe and North Asia. It is the list of countries and dependencies by area, largest country in the world, and extends across Time in Russia, eleven time zones, sharing Borders ...

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 and ) is a state of severe hyperextension and spasticity in which an individual's head, neck and spinal column enter into a complete "bridging" or "arching" position. This extreme arched pose is an extrapyram ...

—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 Polish may refer to: * Anything from or related to Poland, a country in Europe * Polish language * Polish people, people from Poland or of Polish descent * Polish chicken * Polish brothers (Mark Polish and Michael Polish, born 1970), American twin ...

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 terminology, anatomical terms. Motion includes movement of Organ (anatomy), organs, joints, Limb (anatomy), limbs, and specific sections of the body. The terminology used de ...

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', l ...

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

pubic symphysis The pubic symphysis (: symphyses) 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 attache ...

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 that is 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 ...

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