Difference between revisions of "Meningism"

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     <li>정의<br />-수막증<br />-수막을 모방한 증상으로 뇌와 척수의 자극이 특징인 비정상 상태</li>
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     <li>정의<br />
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    -수막을 모방한 증상으로 뇌와 척수의 자극이 특징인 비정상 상태 </li>
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<p><strong>Meningism</strong> is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. It is a sign of irritation of the meninges, such as seen in meningitis, subarachnoid hemorrhages and various other diseases. <em>&quot;Meningismus&quot;</em> is the term used when the above listed symptoms are present without actual infection or inflammation; usually it is seen in concordance with other acute illnesses in the pediatric population. <sup class="reference" id="_ref-0">[1]</sup></p>
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<p>&nbsp;</p>
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<h2><span class="mw-headline">Clinical signs</span></h2>
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<p>The main clinical signs that indicate meningism are <em>nuchal rigidity</em>, <em>Kernig's sign</em> and <em>Brudzinsky's signs</em>. None of the signs are particularly sensitive; in adults with meningitis, nuchal rigidity was present in 30% and Kernig's or Brudzinsky's sign only in 5%.<sup class="reference" id="_ref-Thomas_0">[2]</sup></p>
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<p>&nbsp;</p>
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<h3><span class="mw-headline">Nuchal rigidity</span></h3>
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<p>Nuchal rigidity is the inability to flex the head forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent.</p>
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<p>&nbsp;</p>
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<h3><span class="mw-headline">Kernig's sign</span></h3>
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<p>Kernig's sign (after Vladimir Mikhailovich Kernig, German neurologist 1840-1917) is positive when the leg is fully bent in the hip and knee, and subsequent extension in the knee is painful (leading to resistance).<sup class="reference" id="_ref-1">[3]</sup>. This may indicate subarachnoid haemorrhage or meningitis<sup class="reference" id="_ref-2">[4]</sup>. Patients may also show opisthotonus&mdash;spasm of the whole body that leads to legs and head being bent back and body bowed forward.</p>
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<p>&nbsp;</p>
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<h3><span class="mw-headline">Brudzinski's signs</span></h3>
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<p>Josef Brudzinski (1874-1917), a Polish pediatrician, is credited with several signs in meningitis. The most commonly used sign (Brudzinski's neck sign) is the appearance of involuntary lifting of the legs in meningeal irritation when lifting a patient's head.<sup class="reference" id="_ref-3">[5]</sup><sup class="reference" id="_ref-Thomas_1">[2]</sup></p>
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<p>Other signs attributed to Brudzinsky:<sup class="reference" id="_ref-4">[6]</sup></p>
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    <li>The symphyseal sign, in which pressure on the pubic symphysis leads to abduction of the leg and reflexive hip and knee flexion.<sup class="reference" id="_ref-Brudzinski1916_0">[7]</sup> </li>
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    <li>The cheek sign, in which pressure on the cheek below the zygoma leads to rising and flexion in the forearm.<sup class="reference" id="_ref-Brudzinski1916_1">[7]</sup> </li>
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    <li>Brudzinski's reflex, in which passive flexion of one knee into the abdomen leads to involuntary flexion in the opposite leg, and stretching of a limb that was flexed leads to contralateral extension.<sup class="reference" id="_ref-5">[8]</sup> </li>
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<p>&nbsp;</p>
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<h2><span class="mw-headline">See also</span></h2>
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<ul>
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    <li>Meningitis </li>
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</ul>
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<p>&nbsp;</p>
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<h2><span class="mw-headline">References</span></h2>
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<ol class="references">
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    <li id="_note-0"><strong>^</strong> ICD9Data.com - Diagnosis Codes, Meningismus </li>
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    <li id="_note-Thomas">^ <sup><em><strong>a</strong></em></sup> <sup><em><strong>b</strong></em></sup> <cite style="FONT-STYLE: normal">Thomas KE, Hasbun R, Jekel J, Quagliarello VJ (2002). &quot;The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis&quot;. <em>Clin. Infect. Dis.</em> <strong>35</strong> (1): 46-52. PMID 12060874.</cite><span class="Z3988" title="ctx_ver=Z39.88-2004&amp;rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&amp;rft.genre=article&amp;rft.atitle=The+diagnostic+accuracy+of+Kernig%27s+sign%2C+Brudzinski%27s+sign%2C+and+nuchal+rigidity+in+adults+with+suspected+meningitis&amp;rft.jtitle=Clin.+Infect.+Dis.&amp;rft.date=2002&amp;rft.volume=35&amp;rft.issue=1&amp;rft.au=Thomas+KE%2C+Hasbun+R%2C+Jekel+J%2C+Quagliarello+VJ&amp;rft.pages=46-52&amp;rft_id=info:pmid/12060874&amp;rft_id=http%3A%2F%2Fwww.journals.uchicago.edu%2FCID%2Fjournal%2Fissues%2Fv35n1%2F011298%2F011298.html">&nbsp;</span> </li>
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    <li id="_note-1"><strong>^</strong> Kernig VM (1882). Ein Krankheitssymptom der acuten Meningitis. <em>St Petersb Med Wochensch</em> <strong>7</strong>:398. </li>
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    <li id="_note-2"><strong>^</strong> Talley and O'Connor (2006). Clinical Examination, a Clinical Guide to Physical Diagnosis. <em>Elsevier</em> <strong>5</strong>:363. </li>
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    <li id="_note-3"><strong>^</strong> Brudzinski J (1909). Un signe nouveau sur les membres inf&eacute;rieurs dans les m&eacute;ningites chez les enfants (signe de la nuque). <em>Arch Med Enf</em> <strong>12</strong>: 745-752. </li>
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    <li id="_note-4"><strong>^</strong> <em>doctor/2299</em> at Who Named It </li>
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    <li id="_note-Brudzinski1916">^ <sup><em><strong>a</strong></em></sup> <sup><em><strong>b</strong></em></sup> Brudzinski J (1916). &Uuml;ber neue Symptome von Gehirnhautentz&uuml;ndung und -reizung bei Kindern, insbesondere bei tuberkul&ouml;sen. <em>Berl Klin Wochensch</em> <strong>53</strong>: 686-690. </li>
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    <li id="_note-5"><strong>^</strong> Brudzinsky J (1908). &Uuml;ber die kontralateralen Reflexe an den unteren Extremit&auml;ten bei Kindern. <em>Wien Klin Wochensch</em> <strong>8</strong>: 255-61. </li>
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<p>&nbsp;</p>
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<h2><span class="mw-headline">External links</span></h2>
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    <li><a class="external text" title="http://www.fpnotebook.com/NEU97.htm" href="http://www.fpnotebook.com/NEU97.htm" rel="nofollow">FPnotebook page on meningeal signs</a> </li>
 
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Revision as of 02:18, 5 October 2007

  • 정의
    -수막증
    -수막을 모방한 증상으로 뇌와 척수의 자극이 특징인 비정상 상태

Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. It is a sign of irritation of the meninges, such as seen in meningitis, subarachnoid hemorrhages and various other diseases. "Meningismus" is the term used when the above listed symptoms are present without actual infection or inflammation; usually it is seen in concordance with other acute illnesses in the pediatric population. [1]

<script type="text/javascript"> //<![CDATA[ if (window.showTocToggle) { var tocShowText = "show"; var tocHideText = "hide"; showTocToggle(); } //]]> </script>

 

Clinical signs

The main clinical signs that indicate meningism are nuchal rigidity, Kernig's sign and Brudzinsky's signs. None of the signs are particularly sensitive; in adults with meningitis, nuchal rigidity was present in 30% and Kernig's or Brudzinsky's sign only in 5%.[2]

 

Nuchal rigidity

Nuchal rigidity is the inability to flex the head forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent.

 

Kernig's sign

Kernig's sign (after Vladimir Mikhailovich Kernig, German neurologist 1840-1917) is positive when the leg is fully bent in the hip and knee, and subsequent extension in the knee is painful (leading to resistance).[3]. This may indicate subarachnoid haemorrhage or meningitis[4]. Patients may also show opisthotonus—spasm of the whole body that leads to legs and head being bent back and body bowed forward.

 

Brudzinski's signs

Josef Brudzinski (1874-1917), a Polish pediatrician, is credited with several signs in meningitis. The most commonly used sign (Brudzinski's neck sign) is the appearance of involuntary lifting of the legs in meningeal irritation when lifting a patient's head.[5][2]

Other signs attributed to Brudzinsky:[6]

  • The symphyseal sign, in which pressure on the pubic symphysis leads to abduction of the leg and reflexive hip and knee flexion.[7]
  • The cheek sign, in which pressure on the cheek below the zygoma leads to rising and flexion in the forearm.[7]
  • Brudzinski's reflex, in which passive flexion of one knee into the abdomen leads to involuntary flexion in the opposite leg, and stretching of a limb that was flexed leads to contralateral extension.[8]

 

See also

  • Meningitis

 

References

  1. ^ ICD9Data.com - Diagnosis Codes, Meningismus
  2. ^ a b 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. 
  3. ^ Kernig VM (1882). Ein Krankheitssymptom der acuten Meningitis. St Petersb Med Wochensch 7:398.
  4. ^ Talley and O'Connor (2006). Clinical Examination, a Clinical Guide to Physical Diagnosis. Elsevier 5:363.
  5. ^ Brudzinski J (1909). Un signe nouveau sur les membres inférieurs dans les méningites chez les enfants (signe de la nuque). Arch Med Enf 12: 745-752.
  6. ^ doctor/2299 at Who Named It
  7. ^ a b Brudzinski J (1916). Über neue Symptome von Gehirnhautentzündung und -reizung bei Kindern, insbesondere bei tuberkulösen. Berl Klin Wochensch 53: 686-690.
  8. ^ Brudzinsky J (1908). Über die kontralateralen Reflexe an den unteren Extremitäten bei Kindern. Wien Klin Wochensch 8: 255-61.

 

External links

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