Validity of Meningeal Signs in Suspected Meningitis

Context: Meningitis, a common medical emergency, an inflammation of the meninges. Specifically, meningeal symptoms such as Kernig’s sign, Brudzinski’s sign and neck rigidity are used to diagnose a patient with suspected meningitis. It has been indicated that passive neck flexion extends the nerve roots across the inflamed meninges in patients with meningitis, resulting in discomfort and flexion movements of the lower extremities. However, for meningitis, such symptoms are not pathognomonic. The goal of this study is to confirm meningeal signs in 75 suspected meningitis adults.

Methods: 75 patients admitted to our tertiary hospital with suspected meningitis were chosen and split into 2 groups: meningitis patients (n=62) and meningitis-free patients (n=13). If the CSF WBC count was > 6/cmm, meningitis was assumed to be present. Before lumber puncture, the three meningeal signs noted Kernig’s sign, Brudzinski’s sign and nuchal rigidity in each patient. Calculated sensitivity, precision, and P-value.

Results: Patients with meningitis (n=62) were comparable in demography and clinical appearance to those without meningitis (n=13). Meningeal signs – Of the 62 meningitis patients (WBCs/cmm of CSF ⁇ 6) studied prior to lumbar puncture, 46 (74.2 percent) had neck rigidity, 37 (59.68 percent) had Kernig’s sign, and 18 (29.03 percent) had Brudzinski’s sign. None of the meningeal symptoms (P<0.001) displayed statistical significance. The sign of Kernig had a sensitivity of 60% and precision, 85%, while the sign of Brudzinski had 29% and 92%, respectively. Nuchal rigidity sensitivity and specificity were 74 percent and 77 percent, respectively.

Conclusion: The study suggests that the signs of Kernig and Brudzinski are not susceptible to the detection of meningitis and, therefore, meningitis diagnosis can not be excluded if not present. Of clinical utility, Nuchal rigidity is the only meningeal symptom. The standardization of the clinical method for the elicitation of meningeal signs must be studied in a larger number of patients.

Author (s) Details

Dr. Munish Kumar
Patna Medical College, Patna, India.

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