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Aug 07

I Have Stiff Neck, Can It Be Meningitis?

Meningitis is a disease that can be very serious, especially when it causes bacteria, being potentially deadly. Early treatment with antibiotics can save our lives so it is interesting to know how to detect it. I include this post on the web because, as you know many, meningitis gives rigidity in the neck. We will now see how this is and how important it is.

Meninges are the layers that cover the central nervous system, ie the brain and spinal cord. These layers are three that are called dura mater, pia mater and arachnoids. The infection that affects these structures is called meningitis. In bacterial meningitis we will see affection more specifically in the arachnoid and in the cerebrospinal fluid that is inside.

I Have Stiff Neck, Can It Be MeningitisSymptoms of bacterial meningitis

Meningitis gives four symptoms mainly that are fever, stiff neck, headache and altered mental status. We are going to focus today on how the stiff neck is and how to interpret it. Still I will briefly comment on the other symptoms.

– High fever is almost always present although some people start with hypothermia. In any case there is an alteration of our normal temperature.

– The headache does not go unnoticed when it is present because it is severe and throughout the head. It is not confused with a normal headache.

– Alterations of the mental state consist in that the patient is confused or with severe sleepiness.

– The stiffness of the neck is present in the majority (approximately 90%). Now we will talk about it.

Many patients will not have all the symptoms, only a few. The vast majority will have at least two of these. Here age and other medical circumstances come in play. Other symptoms may also occur but I did not want to complicate the post. Perhaps the best known are purples and petechiae, which are spots and spots red and purple that sometimes go out the body.

How do we verify that neck stiffness is due to meningitis?

Many patients do not complain of neck stiffness because the other symptoms are more striking. This makes it rather a finding in the physical examination that the doctor does to us. Basically the rigidity is that we will not be able to bring the chin to the chest by the pain.

There are two famous tests to evaluate the meningitis that are the signs of Kernig and Brudzinski. The sign of Brudzinski refers to the patient flexing the hips (shrugs the legs) when we try to flex the neck (bring the chin to the chest) while lying on his back.   The sign of Kernig would be similar to the maneuver we make to see if there is sciatica where we lift the leg and the pain would not leave us.

The meninges cover both the brain and the marrow, so they run through the entire spine. Because of this there is a limitation of the mobility of the spine when these meninges are inflamed. Being the neck the one with the most mobility is where it can be noticed.

The problem with these maneuvers is that they usually become positive when the disease is more advanced. Only a few have these signs at the beginning of the disease.

In short, meningitis is a picture that arises with high fevers, intense headache and the patient is sleepy or confused. These are enough reasons to run to the emergency room. The stiffness of the neck will not be the most striking but may be present in the way I have mentioned.

Turning this around: If we have rigidity in the movements of the neck but we are perfectly without another significant symptom, we should not be frightened. The chances of having meningitis are practically nonexistent and will enter into the many lesions we may have at the cervical level. When in doubt always consult with our doctor.

How is meningitis diagnosed?

If we think that we have meningitis we must go quickly to an emergency department. When there is suspicion of the presence of this disease the doctor will do a lumbar puncture. In this way we will have the diagnosis and the guilty microorganism to adjust the treatment if necessary.

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