WordNet

the physical property of being stiff and resisting bending (同)rigidness

PrepTutorEJDIC

三いこと,硬直 / 厳格;厳密,厳正

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/09/21 23:08:39」(JST)

wiki en

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.

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%.^[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 backwards.^{[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

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 成人における急性細菌性髄膜炎の臨床的特徴および診断 clinical features and diagnosis of acute bacterial meningitis in adults
2. 小児における項部硬直に対するアプローチ approach to neck stiffness in children
3. ウイルス性髄膜炎：小児における臨床的特徴および診断 viral meningitis clinical features and diagnosis in children
4. 月齢1ヶ月以上の小児における急性細菌性髄膜炎：臨床的特徴および診断 bacterial meningitis in children older than one month clinical features and diagnosis
5. くも膜下出血の重症度分類 subarachnoid hemorrhage grading scales

English Journal

Regulation of metastatic ability and drug resistance in pulmonary adenocarcinoma by matrix rigidity via activating c-Met and EGFR.

Chang CC1, Hsieh TL2, Tiong TY3, Hsiao CH4, Ji AT2, Hsu WT2, Lee OK5, Ho JH6.
Biomaterials.Biomaterials.2015 Aug;60:141-50. doi: 10.1016/j.biomaterials.2015.04.058. Epub 2015 May 19.
Lung fibrosis is a poor prognostic factor for pulmonary adenocarcinoma, and the effect of a rigid microenvironment on cancer behavior is unclear. We cultured A549 cells on matrices of 0.2, 2, and 25 kPa to mimic the rigidities of normal lung parenchyma, progressive fibrotic change, and lung fibrosi
PMID 26000960

Fibromyalgia: the Prototypical Central Sensitivity Syndrome.

Boomershine CS1.
Current rheumatology reviews.Curr Rheumatol Rev.2015 Jun 18. [Epub ahead of print]
Fibromyalgia syndrome (FM), the most common central sensitivity syndrome (CSS) affecting over 5% of the population, is a disorder of chronic widespread pain accompanied by numerous other symptoms that causes significant functional impairment. The core FM symptom domains can be recalled using the FIB
PMID 26088213

The clinical features, diagnosis, treatment, and prognosis of neuroinvasive listeriosis: a multinational study.

Arslan F1, Meynet E, Sunbul M, Sipahi OR, Kurtaran B, Kaya S, Inkaya AC, Pagliano P, Sengoz G, Batirel A, Kayaaslan B, Yıldız O, Güven T, Türker N, Midi I, Parlak E, Tosun S, Erol S, Inan A, Oztoprak N, Balkan I, Aksoy Y, Ceylan B, Yılmaz M, Mert A.
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology.Eur J Clin Microbiol Infect Dis.2015 Jun;34(6):1213-21. doi: 10.1007/s10096-015-2346-5. Epub 2015 Feb 20.
The aim of this study was to determine the independent risk factors, morbidity, and mortality of central nervous system (CNS) infections caused by Listeria monocytogenes. We retrospectively evaluated 100 episodes of neuroinvasive listeriosis in a multinational study in 21 tertiary care hospitals of
PMID 25698311

Japanese Journal

外転神経麻痺で発症した悪性黒色腫による髄膜癌腫症の1例

中奥由里子,村上学,藤本康子,白瀬智之,今峰倫平,三枝隆博,松井大
臨床神経学 54(8), 675-678, 2014
症例は39歳の男性である．腰部痛が先行し，複視で発症した．激しい頭痛，嘔気嘔吐が出現し，血清髄液をみとめたが，くも膜下出血は否定的であった．髄液細胞数，蛋白の著明な上昇から髄膜炎と診断した．頭部MRIにて左上顎洞に占拠性病変と，脳神経，髄膜，馬尾などに造影効果をみとめた．左上顎洞生検，髄液細胞診より悪性黒色腫の病理診断をえた．副鼻腔の悪性黒色腫はきわめてまれであるが，髄膜癌腫症の原因となることがあ …
NAID 130004679014

胸神経領域の帯状疱疹に脳髄膜炎を併発した1例

嘉山邦仁,中谷俊彦,橋本龍也,齊藤洋司
日本ペインクリニック学会誌 20(2), 107-110, 2013
症例は70歳代の男性で，左背部の痛みを発症し，第3病日に左前胸腹部～左背部に皮疹が出現した．第6病日に当院皮膚科を受診し，帯状疱疹と診断されて入院となった．抗ウイルス薬の治療により皮疹は改善してきたが，痛みが持続するため第12病日に当科へ紹介されて転科となった．診察時，左第7，8，9胸神経領域に痛みを伴う皮疹があり，アロディニアと触覚低下も伴っていた．併存疾患の心房細動の治療として抗凝固療法が行わ …
NAID 130003375365

低血糖で入院後，髄膜炎を発症し細菌性脳動脈瘤の破裂をきたした糖尿病の1例

畑崎聖弘,下川原立雄,酒井保葉,藤田洋平,片岡隆太郎,藤木典隆,狭間洋至,橋本宏之,馬屋原豊
糖尿病 55(4), 264-268, 2012
細菌性動脈瘤は臨床上比較的稀であるが，致死率が高く注意を要する．今回，低血糖で入院後に髄膜炎を発症し，引き続き細菌性脳動脈瘤の破裂をきたした1例を経験したので報告する．症例は78歳の男性，2型糖尿病，高血圧，脳梗塞，前立腺癌などに対し加療されていたが，食思不振による遷延性低血糖のため緊急入院となった．第10病日に発熱・膿尿を認めたため抗生剤治療を開始するも解熱せず，第17病日に項部硬直および髄液検 …
NAID 130004511323