Bacterial meningitis physical examination
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Bacterial meningitis Microchapters |
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Diagnosis |
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Treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
Physical examination of bacterial meningitis may vary in adults and infants. In adults, physical examination findings may include bradycardia, disorientation, papilledema, neck stiffness, positive brudzinski's and kernig's sign. Physical examination findings in infants may include petechial rash, bulging fontanelle, neck stiffness, jaundice and convulsions.
Physical examination
Physical examination of bacterial meningitis may vary in adults and in infants. Following signs may suggest bacterial meningitis:[1][2][3][4][5]
Adults
The physical examination findings in adults may include the following:
General appearance
- Patient may look distressed
- Altered mental status-not oriented in time, place and person
Vital signs
- Bradycardia may indicate increased intracranial pressure
- Increased or decreased temperature
HEENT
- Signs of infection indicating sinusitis, mastoiditis, and otitis media may help identify the source of infection and give a clue about diagnosis.
- Papilledema may indicate increased intracranial pressure.
- Neck stiffness is strongly suggestive of meningitis.
CVS
- Decreased heart rate indicates increased intracranial pressure
CNS
- Signs of neurological deficit may or may not be present.
- Presence of cranial nerve palsy or motor or sensory weakness may suggest complications
Skin
- Presence of skin rash may indicate Neisseria meningitidis infection
Special tests
Following are the special tests for meningitis. Positive tests provide a strong suspicion for meningeal irritation:[6]
- Postive kernig's sign indicate meningitis.
- Positive brudzinski's sign may suggest meningitis
- Jolt accentualtion:[7]
- Exacerbation of headache by moving head in horizontal direction two to three times indicate positive test.
Infants
- Neck stiffenss or hypotonia
- Altered mental status
- Bulging fontanelle
- Convulsions
- Petechial rash
References
- ↑ Attia J, Hatala R, Cook DJ, Wong JG (1999). "The rational clinical examination. Does this adult patient have acute meningitis?". JAMA. 282 (2): 175–81. PMID 10411200.
- ↑ https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047163/ Accessed on Jan 9th, 2017
- ↑ Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.
- ↑ Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS; et al. (1993). "Acute bacterial meningitis in adults. A review of 493 episodes". N Engl J Med. 328 (1): 21–8. doi:10.1056/NEJM199301073280104. PMID 8416268.
- ↑ van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M (2004). "Clinical features and prognostic factors in adults with bacterial meningitis". N Engl J Med. 351 (18): 1849–59. doi:10.1056/NEJMoa040845. PMID 15509818.
- ↑ 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. doi:10.1086/340979. PMID 12060874.
- ↑ Uchihara T, Tsukagoshi H (1991). "Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis". Headache. 31 (3): 167–71. PMID 2071396.