Jolt Accentuation Of Headache Research Articles

Factors affecting diagnostic difficulties in aseptic meningitis: a retrospective observational study

Abstract Objectives The purpose of this study was to determine the actual diagnostic status of aseptic meningitis and consider the factors that cause difficulties in its diagnosis. Methods This study retrospectively reviewed the medical records of aseptic meningitis treated at our hospital from 2013 to 2022 and compared biometric data to distinguish between timely diagnose and difficult diagnose cases. Results This retrospective observational study included 127 patients aged 18 years or older. 66 (52.0 %) were female, with a median age of 35.9±15.9 years. The main symptoms were headache (122, 96.1 %), general malaise (110, 86.6 %), vomiting (79, 62.2 %). The 127 patients were classified into two groups: A timely diagnosis group diagnosed within 6 days of symptom onset, and a difficult diagnosis group diagnosed within 7 days or longer. There were significant differences between the two groups in the proportion of patients with a history of antimicrobial treatment and fever above 38 °C, and in the positive rates of neck stiffness and jolt accentuation of headache (JAH). The total number of hospitals involved in the process of diagnosis was significantly higher in the difficult diagnosis group and the length of inpatient stay was significantly longer. Multivariate analysis revealed significant differences in neck stiffness, JAH, and prior antibacterial therapy. Conclusions Atypical cases, such as neck stiffness and JAH negativity, may make the diagnosis difficult. Clinicians should be aware of this atypical presentation of aseptic meningitis.

Association between aseptic meningitis and jolt accentuation of headache in adults

The purpose of this study was to elucidate the association between aseptic meningitis and jolt accentuation of headache (JAH) in adults. 87 patients with meningeal irritation (age; 35.6 ± 13.3 years old, 45 males) who were admitted to our hospital from 1st August 2013 to 31st August 2018 were included. The diagnosis was determined according to the following criteria:, aseptic meningitis was defined as cerebrospinal fluids (CSF) pleocytosis with no evidence of bacterial infection, fungal infection or carcinomatous findings; meningism was defined as the absence of CSF pleocytosis. None of these patients had consciousness disturbance and focal neurological abnormalities. The blood and CSF data were reviewed for analysis. 61 patients were in aseptic meningitis group, 26 patients were in meningism group. Multiple logistic regression analysis showed older age (OR 1.059, 95% Confidence interval (CI) 1.012-1.108, P = 0.013), lower CRP (OR 0.803, 95%CI 0.697-0.925, P = 0.002) and absence of JAH (OR 0.048, 95%CI 0.004-0.554, P = 0.015) were significantly associated with aseptic meningitis. The sensitivity and specificity of JAH in aseptic meningitis were 68.9%, 3.8%.

Accuracy of Neck stiffness, Kernig, Brudzinski, and Jolt Accentuation of Headache Signs in Early Detection of Meningitis.

The diagnostic value of clinical signs in early diagnosis of meningitis has been evaluated but the existing results are contradicting. The present study aimed to evaluate the accuracy of Kernig, Brudzinski, neck stiffness, and Jolt Accentuation of Headache (JAH) signs in this regard. In this diagnostic accuracy study, patients with suspected meningitis who were referred to the emergency department were examined regarding presence or absence of the mentioned clinical signs and screening performance characteristics of the signs were calculated. Cerebrospinal fluid analysis was used as the reference test. 120 cases with mean age of 48.79 ± 21.68 years (18 - 93) were studied (63.3% male). Diagnosis of meningitis was confirmed for 45 (37.5%) cases. Neck stiffness (p < 0.001), Kernig (p < 0.001), Brudzinski (p < 0.001), and JAH (p < 0.001) had significantly higher frequency among patients with meningitis. The accuracy of neck stiffness, Kernig, Brudzinski, and JAH signs in early detection of meningitis were 0.676 (95% CI: 0.575-0.776), 0.667 (95% CI: 0.552-0.782), 0.720 (95% CI: 0.619-0.821), 0.749 (95% CI: 0.659-839), respectively. It seems that diagnostic value of JAH is higher than other clinical signs but the accuracy of all signs is in poor to fair range. JAH had the highest sensitivity and Kernig and Brudzinski had the highest specificity.

Jolt accentuation of headache and other clinical signs: poor predictors of meningitis in adults

Jolt accentuation or exacerbation of a baseline headache with horizontal rotation of the neck is a physical finding believed to assess for meningeal irritation. We conducted a prospective observational study of neurologically intact emergency department (ED) patients undergoing lumbar puncture in 2 inner city academic EDs to validate the sensitivity and specificity of jolt accentuation and to assess the sensitivity and specificity of Kernig sign, Brudzinski sign, and nuchal rigidity, in predicting cerebrospinal fluid (CSF) pleocytosis in individuals being assessed for meningitis. Adult patients 18 years and older undergoing lumbar puncture between 2006 and 2009 were approached for consent. Exclusions included inability to consent and altered mental status. Physicians were asked to answer a questionnaire of physical examination findings before receiving CSF results. The primary outcome was the presence or absence of pleocytosis, defined as greater than or equal to 5 cells/high-power field in the fourth CSF tube. We calculated descriptive statistics and tests of diagnostic accuracy. A total of 230 patients consented for participation and had CSF white blood cell counts recorded. Forty-seven individuals (20%) had pleocytosis. A total of 197 patients had headache and were, hence, eligible for jolt accentuation assessment. For pleocytosis, the sensitivity of jolt accentuation was 21%, Kernig sign was 2%, Brudzinski sign was 2%, and nuchal rigidity was 13%. The specificity of jolt accentuation was 82%, Kernig sign was 97%, Brudzinski sign was 98%, and nuchal rigidity was 80%. Jolt accentuation in our cohort was poorly predictive of pleocytosis and insensitive. The presence of Kernig sign, Brudzinski sign, or nuchal rigidity has moderate positive but no negative predictive value for pleocytosis.

19 Jolt Accentuation of Headache: Sensitive Enough for Pleocytosis to Rule-Out Need for a Lumbar Puncture in Diagnosing Meningitis?

19 Jolt Accentuation of Headache: Sensitive Enough for Pleocytosis to Rule-Out Need for a Lumbar Puncture in Diagnosing Meningitis?

PP-035 Environmental surveillance for methicillin resistance coagulase negative staphylococci (MRCoNS) in Hospital Universiti Sains Malaysia (HUSM)

Background: Optimal use of the clinical examination aids physicians to identify patients with meningitis risk. The low specificity of the meningeal signs may be due to the presence of cervical arthritis and spondylosis among some patients. One of the most sensitive maneuvers in the diagnosis of meningitis is jolt accentuation of headache. Method: A descriptive research was performed on suspected acute meningitis patients. The patients were evaluated for presence of meningial signs before lumbar puncture. Results: 14 patients were evaluated. There was neck stiffness, Kernig’s, brudzinski’s and jolt sign in 78.6%, 14.3%, 14.3%, and 64.3% of patients respectively. The prevalence, sensitivity and specificity, PPV, NPV, LR+, LR of neck stiffness in comparison with pleocytosis was 50%, 100%, 57%, 70%, 100%, 2.33, and 0 respectively. The prevalence, sensitivity and specificity, PPV, NPV, LR+, LR of jolt sign in comparison with neck stiffness was 78.5%, 82%, 60%, 100%, 60%, 0, and 0.18 respectively. The prevalence, sensitivity and specificity, PPV, NPV, LR+, LR of jolt sign in comparison with pleocytosis was 50%, 100%, 71.5%, 78%, 100%, 1, and 0 respectively. Conclusion: This study shows that in evaluation of suspected meningitis patients who have some limitation to evaluate for neck stiffness, we can evaluate them with jolt sign in examination. The presence of LR (0.18) jolts sign in comparison with neck stiffness shows it is an appropriate sign in these patients. The presence of LR and LR+ (2.33, 0) for neck stiffness shows it is a good and appropriate way to diagnose meningitis. PP-035 Environmental surveillance for methicillin resistance coagulase negative staphylococci (MRCoNS) in Hospital Universiti Sains Malaysia (HUSM) I. Ibrahim1 *, H. Hasan1, Z. Abdul Rahman1. 1Universiti Sains Malaysia, Malaysia

PP-034 Jolt accentuation of headache in diagnosis of acute meningitis

PP-034 Jolt accentuation of headache in diagnosis of acute meningitis

45-Year-Old Woman With Recurrent Headache and Photophobia

45-Year-Old Woman With Recurrent Headache and Photophobia

Viral meningitis and encephalitis

A wide range of viruses can cause meningitis; most cases are caused by enteroviruses (70–90%), genital herpes simplex virus (HSV) or mumps. The typical syndrome of viral meningitis comprises acute onset of fever, headache and accompanying signs of meningeal irritation (photophobia, neck stiffness, Kernig's sign and jolt accentuation of headache). The outlook for most patients with viral meningitis is excellent. Treatment is supportive, and includes provision of adequate analgesia.

The rational clinical examination. Does this adult patient have acute meningitis?

Early clinical recognition of meningitis is imperative to allow clinicians to efficiently complete further tests and initiate appropriate therapy. To review the accuracy and precision of the clinical examination in the diagnosis of adult meningitis. A comprehensive review of English- and French-language literature was conducted by searching MEDLINE for 1966 to July 1997, using a structured search strategy. Additional references were identified by reviewing reference lists of pertinent articles. The search yielded 139 potentially relevant studies, which were reviewed by the first author. Studies were included if they described the clinical examination in the diagnosis of objectively confirmed bacterial or viral meningitis. Studies were excluded if they enrolled predominantly children or immunocompromised adults or focused only on metastatic meningitis or meningitis of a single microbial origin. A total of 10 studies met the criteria and were included in the analysis. Validity of the studies was assessed by a critical appraisal of several components of the study design. These components included an assessment of the reference standard used to diagnose meningitis (lumbar puncture or autopsy), the completeness of patient ascertainment, and whether the clinical examination was described in sufficient detail to be reproducible. Individual items of the clinical history have low accuracy for the diagnosis of meningitis in adults (pooled sensitivity for headache, 50% [95% confidence interval [CI], 32%-68%]; for nausea/vomiting, 30% [95% CI, 22%-38%]). On physical examination, the absence of fever, neck stiffness, and altered mental status effectively eliminates meningitis (sensitivity, 99%-100% for the presence of 1 of these findings). Of the classic signs of meningeal irritation, only 1 study has assessed Kernig sign; no studies subsequent to the original report have evaluated Brudzinski sign. Among patients with fever and headache, jolt accentuation of headache is a useful adjunctive maneuver, with a sensitivity of 100%, specificity of 54%, positive likelihood ratio of 2.2, and negative likelihood ratio of 0 for the diagnosis of meningitis. Among adults with a clinical presentation that is low risk for meningitis, the clinical examination aids in excluding the diagnosis. However, given the seriousness of this infection, clinicians frequently need to proceed directly to lumbar puncture in high-risk patients. Many of the signs and symptoms of meningitis have been inadequately studied, and further prospective research is needed.

Jolt Accentuation of Headache: The Most Sensitive Sign of CSF Pleocytosis

We prospectively examined the clinical signs of 54 febrile patients associated with recent-onset headache. They underwent lumbar puncture (LP) on suspicion of meningitis. The relation of each sign to cerebrospinal fluid (CSF) pleocytosis was estimated. Among 34 patients with pleocytosis, 33 had jolt accentuation (sensitivity: 97.1%), while only 5 of them had neck stiffness or Kernig's sign. Among 20 patients without pleocytosis, 12 had no jolt accentuation (specificity: 60%). We found jolt accentuation to be the most sensitive sign of CSF pleocytosis. If jolt accentuation is noted in a febrile patient associated with recent onset headache, the CSF should be examined even in the absence of neck stiffness or Kernig's sign.