An improved clinical method for detecting meningeal irritation.

Vincent, Johny; Kim, Thomas

doi:10.1136/adc.68.2.215

Cited by 12 publications

(9 citation statements)

References 2 publications

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“…The code "meningeal signs" applies to patients with neck pain in the history, or with meningeal irritation assessed by either the general practitioner or the paediatrician. Meningeal irritation was de ned as presence of Brudzinski sign I or II, Kernig sign, tripod phenomenon or neck stiffness in children aged >1 y, and in children aged µ1 y one of the previous signs or irritability during manipulation of the head or legs by the paediatrician, or a bulging fontanelle (4,13). In children with missing information on some tests, but with at least 1 positive sign, meningeal irritation was considered present.…”

Section: Methodsmentioning

confidence: 99%

Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures

Oostenbrink¹,

Moons²,

Donders³

et al. 2001

Acta Paediatrica

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Section: Methodsmentioning

confidence: 99%

Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures

Oostenbrink¹,

Moons²,

Donders³

et al. 2001

Acta Paediatrica

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“…Depth of coma was assessed by Modified Glasgow Coma Scale [11]. Vincent's sign [12] is a meningeal sign that is elicited by having the child sit up in bed with legs extended in front of him. The neck is gently flexed.…”

Section: Methodsmentioning

confidence: 99%

Sensitivity and specificity of clinical features and blood counts in childhood meningoencephalitis

Kumar

Kanta

et al. 2015

J Pediatr Neurol

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Meningoencephalitides (ME) are an important group of disorders that constitute a medical emergency in any age group, more so in children. The physician uses the lumbar puncture (LP) as a diagnostic test to confirm or exclude the diagnosis of ME. Of all the LPs ordered, ME is found in only a small proportion. The need for LP is often alarming to the family. The diagnostic accuracy of different clinical symptoms and signs may therefore help the physician in being more discriminative in use of LP. Setting Pediatric wards of a teaching hospital in Northern India. Methods Consecutive children between one month and 12 years of age undergoing LP on the suspicion of ME on three preselected weekdays were enrolled in the study and all relevant clinical features, total and differential leukocyte counts in blood were recorded. Outcome measurement was presence or absence of ME diagnosed on the basis of cerebrospinal fluid (CSF) examination for cells, protein, sugar and bacterial culture. Clinical features, total and differential leukocyte counts were compared in ME and nonME groups. Sensitivity and specificity of clinical features were computed and logistic regression and stratified analysis by age performed. Results One hundred and nineteen patients were enrolled, of which 35 (29.4% had ME. Only one symptom, headache, was significantly more common in ME. All the meningeal signs were more common in ME with sensitivity being highest for Vincent's sign (76.9%. Tense, bulging anterior fontanelle, focal neurological deficit, and mean polymorphonuclear (PMN) leukocyte percentage in blood were also significantly higher in ME. Logistic regression showed that only neck rigidity and PMN leukocyte percentage were significant independent predictors of ME. In children beyond 24 months of age, fever was present in 19 out of 20 cases of ME. Presence of fever and headache achieved high sensitivity while neck rigidity, Vincent's sign and focal deficits had high specificity in this age group. In children below 12 months of age, none of the signs achieved adequate accuracy. Conclusions In hospitalized children undergoing LP on suspicion of ME, neck stiffness along with high PMN leukocyte percent (>80%) in peripheral blood are highly suggestive of ME. Absence of fever beyond two years of age almost rules out ME. However, no clinical features are adequately discriminative for the diagnosis of ME in infants.

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“…Examination of the patient in the sitting position with knees extended increased the sensitivity and specificity of the maneuvers. 15 Second, the difference in sensitivity and specificity may be because of the age of the patients. Kernig and Brudzinski described their signs predominantly in children.…”

Section: Sensitivity and Specificity Of The Signsmentioning

confidence: 99%

“…It is important to note that the maneuver can only be performed in conscious patients who are able to sit up. 14,15 Polish neurophysiologist Gustav Bikeles' 16 (1861-1918) eponymous sign (Bikeles' Sign) consists of having the patient flex their elbow and abduct and externally rotate their shoulder. Passive extension of the elbow is limited when there is meningeal irritation.…”

mentioning

confidence: 99%

The History and Current Relevance of the Eponymous Signs of Meningitis

Forgie

2016

Pediatric Infectious Disease Journal

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During the past several decades, researchers have shown that the eponymous signs of meningitis have reduced sensitivity and specificity compared with when they were originally described. This may be because of the changing epidemiology of meningitis and its treatment or it may be because of variations in performance of the maneuvers. For example, in the original descriptions, the Kernig sign (resistance of leg extension) is best elicited with the patient sitting and the Brudzinski nape of the neck sign involves holding down the patient's chest as the neck is flexed. These and other lesser-known signs of meningitis by Amoss, Bikeles and Edelmann all relate to the mechanics of stretching inflamed meninges, and this review will allow the clinician to understand how the history related to these maneuvers is still germane to clinical practice today.

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An improved clinical method for detecting meningeal irritation.

Cited by 12 publications

References 2 publications

Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures

Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures

Sensitivity and specificity of clinical features and blood counts in childhood meningoencephalitis

The History and Current Relevance of the Eponymous Signs of Meningitis

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