Diagnostic Testing for Meningitis
History:
 • Triad: Fever, neck stiffness, and altered mental status
 • Sens: 44% if 2+ are present; Spec: Non-specific
Kernig Sign:
 • Leg extension → pain in back/thighs or extension
 • Sens: 5% (40% if sitting up); Spec: 95%
Brudzinski Sign
 • Passively flex neck and legs will flex 
 • Sens: 5%; Spec: 95%
Nuchal Rigidity 
 • Neck stiffness with neck flexion 
 • Sens: 30%; Spec: 70%
Jolt Accentuation
 • Shake head will headache 
 • Sens: 60-90%; Spec: 60-80%
Lumbar Puncture
 • Glucose, WBC, protein, gram stain, culture 
 • Sens: 60-90%; Spec: Up to 100%

- VA Joint Chiefs @BostonChiefs

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