What are the meningeal signs of aseptic meningitis?

Updated: Jul 17, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Neck stiffness in meningitis is tested by gentle forward flexion of the neck with the patient lying in the supine position. Meningeal irritation also can be tested by the jolt accentuation of headache. This is elicited by asking the patient to turn his or her head horizontally at a frequency of 2-3 rotations per second. Worsening of a baseline headache represents a positive sign.

Severe meningeal irritation may result in the patient assuming the tripod position (termed Amoss sign or Hoyne sign) with the knees and hips flexed, the back arched lordotically, the neck extended, and the arms brought back to support the thorax.

When passive neck flexion in a supine patient results in flexion of the knees and hips, the Brudzinski sign is positive. Yet another Brudzinski sign, the contralateral reflex, is present if passive flexion of one hip and knee causes flexion of the contralateral leg.

Kernig sign is elicited with the patient lying supine and the hip flexed at 90°. A positive sign is present when extension of the knee from this position elicits resistance or pain in the lower back or posterior thigh.

Papilledema or absence of venous pulsations upon funduscopic examination indicates increased intracranial pressure.


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