Jolt Accentuation of Headache in Diagnosis of Acute Meningitis

Optimal use of the clinical examination aids physicians in identifying patients at risk for meningitis. The low specificity of the meningeal signs may be due to the presence of cervical arthritis and spondylosis. One of the most sensitive maneuvers in the diagnosis of meningitis is jolt accentuation of headache.

Patients and methods:

A descriptive research was performed on suspected acute meningitis patients. The patients were evaluated for presence of meningeal signs before lumbar puncture. Sensitivity, specificity, positive and negative predictive values, likelihood-ratio-positive (LR+), and likelihood-ratio-negative (LR-) were determined. A p-value of <0.05 was considered to be statistically significant.

Results:

Totally, 14 patients were evaluated. Neck stiffness, Kernig, Brudzinski and jolt accentuation sign were positive in 78.6%, 14.3%, 14.3%, and 64.3% of patients, respectively. The prevalence, sensitivity, specificity, PPV, NPV, LR+, and LR- of neck stiffness in comparison with pleocytosis was 50%, 100%, 57%, 70%, 100%, 2.33, and 0, respectively. The prevalence, sensitivity, specificity, PPV, NPV, LR+, and LR- of jolt accentuation sign in comparison with neck stiffness was 78.5%, 82%, 60%, 100%, 60%, 0, and 0.18, respectively, however, when jolt accentuation sign was compared with pleocytosis these parameters were 50%, 100%, 71.5%, 78%, 100%, 1, and 0, respectively.

Conclusion:

When evaluating suspected cases of meningitis with limitations for neck stiffness examination, we can alternatively evaluate jolt accentuation sign. The LR- of 0.18 for jolt accentuation sign when compared with neck stiffness revealed that jolt accentuation sign is an appropriate maneuvers in the diagnosis of meningitis.

Keywords

Meningitis

Neck stiffness

Pleocytosis

Jolt accentuation sign

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