Jolt accentuation of headache and other clinical signs: poor predictors of meningitis in adults

Nakao, Jolene H; Jafri, Farrukh N; Shah, Kaushal; Newman, David H.

doi:10.1016/j.ajem.2013.09.012

Cited by 48 publications

(36 citation statements)

References 10 publications

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“…These studies collectively demonstrate that these signs have low sensitivity in predicting cerebrospinal fluid (CSF) pleocytosis (Table 1). 10,16,17 The absence of these clinical signs, therefore, cannot adequately rule out of the presence of meningitis or obviate the need for a lumbar puncture (LP). However, Kernig’s and Brudzinski’s signs are quite specific (92 – 98%) for predicting CSF pleocytosis and therefore, their presence should increase clinical suspicion for meningitis.…”

Section: Meningitismentioning

confidence: 99%

Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

Dorsett

Liang

2016

Emergency Medicine Clinics of North America

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Central nervous system (CNS) infections, including meningitis, encephalitis, and brain abscess, are rare but time-sensitive emergency department (ED) diagnoses. Patients with CNS infection can present to the ED with a host of non-specific signs and symptoms, including headache, fever, altered mental status, and behavioral changes. In meningitis, the classic triad of fever, neck stiffness, and altered mental status occurs in only a minority of patients. Classic physical examination maneuvers, such Kernig’s and Brudzinski’s signs, are relatively insensitive although specific for predicting cerebrospinal fluid (CSF) pleocytosis. Patients with parenchymal involvement, as occurs with encephalitis and brain abscess, may also have focal neurologic deficits or seizures. Neuroimaging and CSF fluid analysis can appear benign early in the course of meningitis and encephalitis, and clinicians should not be falsely reassured. Delaying antibiotic and antiviral therapies negatively impacts outcomes, particularly with bacterial meningitis and herpes simplex virus encephalitis. As with other rare, life-threatening diagnoses encountered in emergency medicine, the diagnosis and treatment of CNS infections requires vigilance and a high index of suspicion based on the history and physical examination which must be confirmed with appropriate imaging and laboratory evaluation.

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Section: Meningitismentioning

confidence: 99%

Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

Dorsett

Liang

2016

Emergency Medicine Clinics of North America

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“…However, clinical symptoms and physical signs are often not present, and lack the ability to differentiate the etiology of meningitis. Nakao et al M a n u s c r i p t 11 reported the sensitivities of fever, headache, vomiting, and rash for predicting pleocytosis in the CSF to be only 0.20, 0.91, 0.04, and 0.02, respectively [43]. Furthermore, the traditionally used meningeal signs i.e.…”

Section: Discussionmentioning

confidence: 99%

The role of serum procalcitonin in the diagnosis of bacterial meningitis in adults: a systematic review and meta-analysis

Vikse

Henry

Roy

et al. 2015

International Journal of Infectious Diseases

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“…It had a sensitivity of only 21% and a specificity of 83% for the diagnosis in recent studies 6. It can be falsely positive if CDS would be asked whether the neck pain would become worse when the neck rotation is provided as it happened in our case.…”

Section: Discussionmentioning

confidence: 65%

Jolt accentuation of neck pain: a novel physical finding for crowned dens syndrome

Kurihara¹,

Tokuda²

2016

BMJ Case Reports

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Crowned dens syndrome (CDS), a pseudogout attack involved with atlantoaxial joint, mimics meningitis, because jolt accentuation of headache, a physical sign for meningitis, is frequently considered mistakenly as 'positive' in CDS patients. Our patient with CDS experienced multiple ambulance transports and underwent lumbar puncture for suspected meningitis because of positive result of jolt accentuation of headache. We found that the patient actually had jolt accentuation of neck pain from CDS and treated her successfully. The characteristic physical finding produced by axial neck rotation in CDS patients is not headache, but a jolt accentuation of neck pain.

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Jolt accentuation of headache and other clinical signs: poor predictors of meningitis in adults

Cited by 48 publications

References 10 publications

Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department

The role of serum procalcitonin in the diagnosis of bacterial meningitis in adults: a systematic review and meta-analysis

Jolt accentuation of neck pain: a novel physical finding for crowned dens syndrome

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