Meningitis physical examination: Difference between revisions

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{{Meningitis}}
{{Meningitis}}


{{CMG}}; '''Associate Editor(s)-In-Chief:'''  {{CZ}}
{{CMG}}; '''Associate Editor(s)-In-Chief:'''  {{CZ}}, {{JH}}.


==Overview==
==Physical Examination==
Meningitis is a [[medical emergency]], and referral to a hospital is indicated.
 
===Skin===
Rapidly-spreading [[petechial rash]] is typical in "meningococcal" meningitis, and may precede other symptoms. The rash consists of numerous small, irregular purple or red spots on the trunk, lower extremities, mucous membranes, conjunctiva, and occasionally on the palms of hands and soles of feet.
 
===Gallery===
 
====Trunk====
 
<gallery>
 
Image: Meningitis_01.png| Meningitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=287}}</ref></small></small>
 
Image: Meningitis_02.jpg| Meningititis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=287}} </ref>></small></small>
 
</gallery>
 
====Extremities====
 
<gallery>


==Physical Examination==
Image: Meningitis_03.jpeg| Meningitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=287}} </ref></small></small>
The suspicion of meningitis is generally based on the nature of the symptoms and findings on [[physical examination]]. Meningitis is a [[medical emergency]], and referral to hospital is indicated. If meningitis is suspected based on clinical examination, early administration of [[antibiotic]]s is recommended, as the condition may deteriorate rapidly. In the hospital setting, initial management consists of stabilization (e.g. securing the [[airway]] in a depressed level of consciousness, administration of [[intravenous fluid]]s in [[hypotension]] or [[Shock (medical)|shock]]), followed by antibiotics if not already administered.


Nuchal rigidity is typically assessed with the patient lying [[Supine position|supine]], and both hips and knees flexed. If pain is elicited when the knees are passively extended ([[Kernig's sign]]), this indicates nuchal rigidity and meningitis. In infants, forward flexion of the neck may cause involuntary knee and hip flexion ([[Brudzinski's sign]]). Although commonly tested, the sensitivity and specificity of Kernig's and Brudzinski's tests are uncertain.<ref name=Thomas_2002>{{cite journal |author=Thomas KE, Hasbun R, Jekel J, Quagliarello VJ |title=The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis |journal=Clin. Infect. Dis. |volume=35 |issue=1 |pages=46-52 |year=2002 |pmid=12060874 |doi=}}</ref>
</gallery>


In "meningococcal" meningitis (i.e. meningitis caused by the bacteria [[Neisseria meningitidis]]), a rapidly-spreading [[petechial rash]] is typical, and may precede other symptoms. The rash consists of numerous small, irregular purple or red spots on the trunk, lower extremities, mucous membranes, conjunctiva, and occasionally on the palms of hands and soles of feet.
===Neurologic===
* Nuchal rigidity is typically assessed with the patient lying [[Supine position|supine]].
* [[Kernig's sign]]: Pain is elicited when the knees are passively extended .
* [[Brudzinski's sign]]: In infants, forward flexion of the neck may cause involuntary knee and hip flexion. Although commonly tested, the sensitivity and specificity of Kernig's and Brudzinski's tests are uncertain.<ref name=Thomas_2002>{{cite journal |author=Thomas KE, Hasbun R, Jekel J, Quagliarello VJ |title=The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis |journal=Clin. Infect. Dis. |volume=35 |issue=1 |pages=46-52 |year=2002 |pmid=12060874 |doi=}}</ref>


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
 
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[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Diseases involving the fasciae]]
[[Category:Inflammations]]
[[Category:Neurological disorders]]

Latest revision as of 22:42, 29 July 2020

Meningitis Main Page

Patient Information

Overview

Causes

Classification

Viral Meningitis
Bacterial Meningitis
Fungal Meningitis

Differential Diagnosis

Diagnosis

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2], Jesus Rosario Hernandez, M.D. [3].

Physical Examination

Meningitis is a medical emergency, and referral to a hospital is indicated.

Skin

Rapidly-spreading petechial rash is typical in "meningococcal" meningitis, and may precede other symptoms. The rash consists of numerous small, irregular purple or red spots on the trunk, lower extremities, mucous membranes, conjunctiva, and occasionally on the palms of hands and soles of feet.

Gallery

Trunk

Extremities

Neurologic

  • Nuchal rigidity is typically assessed with the patient lying supine.
  • Kernig's sign: Pain is elicited when the knees are passively extended .
  • Brudzinski's sign: In infants, forward flexion of the neck may cause involuntary knee and hip flexion. Although commonly tested, the sensitivity and specificity of Kernig's and Brudzinski's tests are uncertain.[2]

References

  1. ↑ 1.0 1.1 1.2 "Dermatology Atlas".
  2. ↑ 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. PMID 12060874.

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