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symptoms that mimic those of meningitis but without inflammation of the meninges

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/15 08:34:17」(JST)

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Meningism is the triad of nuchal rigidity (neck stiffness), photophobia (intolerance of bright light) and headache. It is a sign of irritation of the meninges, such as seen in meningitis, subarachnoid hemorrhages 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.^[1] Related clinical signs include Kernig's sign and three signs all named Brudzinski's sign.

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%.^[2]

Nuchal rigidity

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

Kernig's sign (after Waldemar Kernig (1840–1917), a Baltic German neurologist) is positive when the thigh is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance).^[3] This may indicate subarachnoid hemorrhage or meningitis.^[4] 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

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.^[2]^[5]

Other signs attributed to Brudzinski:^[6]

The symphyseal sign, in which pressure on the pubic symphysis leads to abduction of the leg and reflexive hip and knee flexion.^[7]
The cheek sign, in which pressure on the cheek below the zygoma leads to rising and flexion in the forearm.^[7]
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.^[8]

References

^ ICD9Data.com - Diagnosis Codes, Meningismus
^ ^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.
^ Kernig VM (1882). "Ein Krankheitssymptom der acuten Meningitis". St Petersb Med Wochensch 7: 398.
^ 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.
^ 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.
^ doctor/2299 at Who Named It?
^ ^a ^b Brudzinski J (1916). "Über neue Symptome von Gehirnhautentzündung und -reizung bei Kindern, insbesondere bei tuberkulösen". Berl Klin Wochensch 53: 686–90.
^ Brudzinski J (1908). "Über die kontralateralen Reflexe an den unteren Extremitäten bei Kindern". Wien Klin Wochensch 8: 255–61.

External links

FPnotebook page on meningeal signs
Image of Kernig's sign

UpToDate Contents

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English Journal

Case report: Detection of rotavirus RNA in the cerebrospinal fluid of a child with rotavirus gastroenteritis and meningism.

Medici MC, Abelli LA, Guerra P, Dodi I, Dettori G, Chezzi C.SourceSection of Microbiology, Department of Pathology and Laboratory Medicine, School of Medicine, University of Parma, Parma, Italy. mariacristina.medici@unipr.it.
Journal of medical virology.J Med Virol.2011 Sep;83(9):1637-40. doi: 10.1002/jmv.22156.
Although case reports have described detection of rotavirus (RV) in extraintestinal sites such as the liver, kidney, and central nervous system (CNS) of children with RV gastroenteritis, CNS localization in RV infection seems to be rare. RT-PCR and nucleotide sequencing detected a G1P[8] strain in t
PMID 21739456

Can urgency classification of the Manchester triage system predict serious bacterial infections in febrile children?

Nijman RG, Zwinkels RLj, van Veen M, Steyerberg EW, van der Lei J, Moll HA, Oostenbrink R.SourceDepartment of General Paediatrics, Erasmus MC - Sophia Children's Hospital, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands; r.oostenbrink@erasmusmc.nl.
Archives of disease in childhood.Arch Dis Child.2011 Aug;96(8):715-22. Epub 2011 Apr 20.
Objective To evaluate the discriminative ability of the Manchester triage system (MTS) to identify serious bacterial infections (SBIs) in children with fever in the emergency department (ED) and to study the association between predictors of SBI and discriminators of MTS urgency of care. Methods Thi
PMID 21508058

Japanese Journal

Adult Meningism and Viral Meningitis, 1997-2004: Clinical Data and Cerebrospinal Fluid Cytokines

Nagafuchi Masako,Nagafuchi Yoshiro,Sato Rumi,Imaizumi Toshihiro,Ayabe Mitsuyoshi,Shoji Hiroshi,Ichiyama Takashi
Internal Medicine 45(21), 1209-1212, 2006
… Objective: Although meningism manifesting acute headache has been observed to be associated with common viral and bacterial infections, its definition and pathogenesis have not been clarified. … Clinical findings and cerebrospinal fluid (CSF) cytokines in adult patients with meningism were investigated and compared with those in viral meningitis. …
NAID 130000076609

Spontaneous Intracranial Hypotension Associated With Bilateral Chronic Subdural Hematomas

MURAKAMI Mineko,MORIKAWA Kentaro,MATSUNO Akira,KANEDA Kenshi,NAGASHIMA Tadashi
Neurologia medico-chirurgica 40(9), 484-488, 2000-09-15
… A 34-year-old female presented with spontaneous intracranial hypotension(SIH)manifesting as severe postural headache and meningism. …
NAID 110002279934