Meningismus

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Meningismus
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Specialty scores for Meningismus

Overview

Meningismus also referred to as meningism or pseudomeningitis is a constellation of signs and symptoms that resemble meningitis but are not due to an actual inflammation of the meninges. Instead, meningismus is caused by meningeal irritation unrelated to meningitis. It is, therefore, imperative to distinguish this benign condition from the acute and potentially lethal inflammation of the meninges.

Clinical Significance and Etiology

Meningismus is now recognized as a common cause of chronic headaches in children.

The most widely accepted theory for the development of meningism is the autoimmune theory. According to this theory, meningismus occurs as an autoimmune response to infection, preferably streptococcal infection. Children start complaining of headaches approximately 1-2 months after this bacterial infection, and the cause of headaches in the majority of cases revealed is anti-streptococcal antibodies, indicating an autoimmune phenomenon.

Another infection proposed to provoke meningismus is Ebstein-Barr virus (EBV). Kids with new daily persistent headaches are sometimes found to suffer from an active EBV infection, as demonstrated by excretion of the virus in the oropharynx or by detecting an antibody titer to the virus.

Minor trauma to the head or neck, lifting heavy weights, and severe coughing can also trigger the sterile inflammation of the meninges.

Signs and Symptoms

Meningismus manifests with the classical triad of meningitis:

  • Headache
  • Neck stiffness: Neck is so sore that it interferes with the ability to lower the chin to the chest
  • Photophobia
  • Other signs of meningitis like Kernig's and Brudzinki's sign may also be apparent on examination.

Diagnosis

Diagnosis of meningismus is typically clinical. The significance of taking a thorough history cannot be underrated. However, other investigations like a lumbar puncture and/or a CT scan may be performed to exclude infection of meninges.

Treatment

Bed rest in a recumbent position alleviates headache as well as the meningeal signs associated with meningismus. The meningeal signs are monitored during the course of bed rest.