Common signs observed in these patients were focal neurological signs in 1 (0.5%), bulging fontanels in 14 (7.3%), neck stiffness in 53 (27.6%), Kernig's sign
in 26 (13.5%), Brudzincski's sign in 18 (9.4%), reduced or deteriorating level of consciousness in 4 (2.1%), dilated poorly reactive pupils in 2 (1%), hypertension in 1 (0.5%), and irregular respiration in 1 (0.5%) patient.
B-Nerve root irritation in meningitis can be assessed by the nurse as a positive Kernig's sign
when the nurse flexes the patient's leg at the hip, holding the leg at a 90 degree angle, then attempts to extend the leg, eliciting pain (Sommers & Johnson, 2008).
By my count there were at least 23 such red flags in this case (a record?), including lifelong otorrhea, profuse watery discharge, glucose and protein in ear fluid, drowsiness, headache, fever, disorientation, seizures, Kernig's sign
, papilledema, meningitis, abscesses (mastoid, cerebellar, and Bezold's), sigmoid sinus thrombosis, otitic hydrocephalus, cholesteatoma, and fistulas (via the sinus plate, dura, round and oval windows, and horizontal and superior semicircular canals).
Patients with spontaneous SAH present with a sudden onset of severe headache (97%), classically described as "the worst headache of my life." Meningeal signs, such as nuchal rigidity, positive Kernig's sign
, or Brudzinski's sign, may also be noted (Greenberg, 2001).
Her temporal artery was palpable bilaterally, and there was no evidence of Brudzinski's or Kernig's sign
The diagnostic accuracy of Kernig's sign
, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis.