Physical exam-acute bacterial meningitis

• Brudzinski and Kernig signs of meningeal irritation appear unreliable for diagnosis or ruling out of meningitis.

• 低sensitvity aka 有病的只有少數有陽

• 高specificity aka 沒病的大多為陰， 但不代表為陰就是沒病

• (CID 2002;35:46; Am J Emerg Med 2013;31:1601)

• Nuchal rigidity (Se 30%, Sp 68%), Kernig’s sign (Se 5%, Sp 95%), Brudzinski’s sign (Se 5%, Sp 95%), jolt sign (HA worsens w/ horizontal rotation) (Se 64%, Sp 43%)

• ± Focal neuro findings (~30%; hemiparesis, aphasia, visual field cuts, CN palsies)

• ± HEENT findings: sinus tenderness, clear rhinorrhea (CSF leak)

• ± Skin and joint findings:

  • petechial rash (N. meningitidis),
  • genital or oral ulcers (HSV),
  • arthritis with joint effusion (N. meningitidis)