strength in numbers: meningitis

7 Apr

just to keep you honest (highlights via this EMdocs article)

“classic triad” (fever, altered mental status, stiff neck)

  • 95% had fever,
  • 88% had neck stiffness,
  • 78% had altered mental status.
  • only 44% of patients with meningitis had all three 


Neck pain: 28% sensitivity

headache: 50% sensitivity


avoid minimizing afebrile patients, especially in the elderly population: as many as 18% of these patients with meningeal infection may be afebrile

Kernig and Brudzinski signs

  • 95% specificity
  • sensitivity is as low as 5%.


“jolt test” (headache accentuated by horizontal rotation of the head at a frequency of two to three times per second)

  •  sensitivities ranging from 97% to 21%


opening pressure: as many as 9% are less than 14 cm/H20


their conclusion: “Ultimately, outside of a positive CSF culture, no one test or exam should rule in or out the diagnosis of meningitis
References: emdocs article; picture


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