II. Causes
- Intracranial causes
- Intracranial Mass (esp. Posterior fossa tumor)
- Subarachnoid Hemorrhage
- Meningitis
- Meningismus
- Increased Intracranial Pressure
- Extracranial Causes
- Retropharyngeal or cervical Lymphadenitis (especially young children)
- Retropharyngeal Abscess or Cellulitis
- Sinusitis
- Mastoiditis
- Torticollis
- Dystonic Reaction
- Cervical SpineOsteomyelitis
- Upper lobe Pneumonia
III. Efficacy: Meningeal signs
- Do not rely on these signs due to low efficacy
- Kernig's Sign and Brudzinski's Sign
- Test Sensitivity: 5%
- Test Specificity: 95%
- Nuchal Rigidity
- Test Sensitivity: 30%
- Test Specificity: 68%
- References
IV. Exam: Nuchal Rigidity
- Involuntary Muscle spasm limits passive neck flexion
- Patient cannot flex neck to place chin on chest
- Unreliable in age under 18 months due to underdeveloped neck musculature
V. Exam: Spinal Rigidity
- Erector spinae Muscle spasm limits spine movement
- Opisthotonos (rigid arched back) may occur
VI. Exam: Kernig's Signs
- Technique
- Patient supine
- Flex both hip and knee to 90 degrees
- Hold hip immobile and extend knee
- Positive Test suggesting Meningeal Irritation
- Resistance to knee extension
- Pain in hamstrings
VII. Exam: Brudzinski's Sign
- Technique
- Patient supine
- Immobilize trunk against bed
- Flex neck, chin to chest
- Positive Test suggesting Meningeal Irritation
- Involuntary hip flexion