neurologic disorders
Overview of Meningitis
Symptoms and Signs of Meningitis
Symptoms and signs of the different types of meningitis may vary, particularly in severity and acuity. However, all types tend to cause the following (except in infants and sometimes in the very old and in immunosuppressed patients): Headache Fever Nuchal rigidity (meningismus) Patients may appear lethargic or obtunded. Nuchal rigidity,a key indicator of meningeal irritation, is resistance to passive or volitional neck flexion. Nuchal rigidity may take time to develop. Clinical tests for it, from least to most sensitive, are Kernig sign (resistance to passive knee extension) Brudzinski sign (full or partial flexion of the hips and knees when the neck is flexed) Difficulty touching the chin to the chest with the mouth closed Difficulty touching the forehead or chin to the knee Nuchal rigidity can be distinguished from neck stiffness due to cervical spine osteoarthritis or influenza with severe myalgia; in these disorders, neck movement in all directions is usually affected. In contrast, nuchal rigidity due to meningeal irritation affects mostly neck flexion; thus, the neck can usually be rotated but cannot be flexed. 