A NEW CLINICAL SIGN IN MENINGITIS-JAMIL’S SIGN

Authors

  • Shahid Jamil Dept. of Medicine, Khyber Medical College/Teaching Hospital, Peshawar, PK 25000
  • Syed Shahmeer Raza Dept. of Physiology, Khyber Medical College/Teaching Hospital, Peshawar, PK 25000
  • Sohrab Khan Dept. of Medicine, Khyber Medical College/Teaching Hospital, Peshawar, PK 25000
  • Mashal Jamil Dept. of Medicine, Rehman Medical Institute, Peshawar, Khyber Pakhtunkhwa, PK 25000

DOI:

https://doi.org/10.55519/JAMC-01-8696

Abstract

Background: This study explored a new clinical sign in meningitis: neck stiffness in lateral position, also known as Jamil’s sign. Methods: A patient was placed in the left lateral position. The examiner held the patient’s occiput with his left hand and the chin with his right hand. Then, the examiner performed a manoeuvre by fully extending and then fully flexing the neck. By doing so, the examiner was able to get ample time and range of movement to judge the tone. The tone was assessed during flexion and extension. If the examiner felt resistance, rigidity, or stiffness while performing this manoeuvre, Jamil’s sign was present. Otherwise, it was supple, and Jamil’s sign was absent. Results: Of the 419 patients, Jamil’s sign was present in 362 patients and absent in 57 patients. Upon lumbar puncture, 361 patients had meningitis, and 58 patients did not have meningitis. Among patients with meningitis, Jamil’s sign was present in 357 patients and absent in four patients. Jamil’s sign had a sensitivity of 98.89% and a specificity of 91.38%. Conclusion: Due to its high sensitivity and specificity for the diagnosis of meningitis, Jamil’s sign obviates the need for unnecessary lumbar puncture, which is performed in doubtful situations of neck stiffness in the supine position

Author Biography

Shahid Jamil, Dept. of Medicine, Khyber Medical College/Teaching Hospital, Peshawar, PK 25000

Professor

References

Roos KL. Mycobacterium tuberculosis meningitis and other etiologies of the aseptic meningitis syndrome. Semin Neurol 2000;20(3):329–35.

Kung D, Nguyen T, Das R. Meningitis and Encephalitis. In Absolute Case-Based Neurology Review. Springer, Cham. 2019; p.121–7.

Zunt JR, Baldwin KJ. Chronic and subacute meningitis. Continuum (Minneap Minn) 2012;18(6):1290–318.

Sharma RR, Sharma A. Meningitis: current understanding and management. In The Microbiology of Central Nervous System Infections. Elsevier, London. 2018; p.3–27.

Zhou F. Inflammatory diseases of the meninges. In: Gao B, Li H, Law M, editors. Imaging of CNS Infections and Neuroimmunology. Springer, Singapore. 2019; p.193–99.

Swartz MN. Bacterial meningitis--a view of the past 90 years. N Engl J Med 2004;351:1826–8.

Takhar SS, Ting SA, Camargo Jr CA, Pallin DJ. U.S. emergency department visits for meningitis, 1993-2008. Acad Emerg Med 2012;19(6):632–9.

Meningitis. What is Meningitis’s status in Pakistan? EPI (Extended Program on Immunization) Govt. of Pakistan. [Internet]. [cited 2020 Sep]. Available from: http://www.epi.gov.pk/vaccine-preventable-diseases/meningitis/#:~:text=Every%20year%2C%20too%2C%20an%20estimated,studies%20have%20not%20been%20conducted

Thomas KE, Hasbun R, Jekel J, Quagliarello VJ. The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis. Clin Infect Dis 2002;35(1):46–52.

Boswell GM. Examination of the Nervous System. In: Cox CL, editor. Pocket Guide to Physical Assessment. John Wiley & Sons, New Jersey. 2019; p.200–30.

Liu S, Lafage R, Smith JS, Protopsaltis TS, Lafage VC, Challier V, et al. Impact of dynamic alignment, motion, and center of rotation on myelopathy grade and regional disability in cervical spondylotic myelopathy. J Neurosurg Spine 2015;23(6):690–700.

Jamil S. Study of skin lesions in 221 patients of meningococcal disease. J Pak Med Assoc 1989;39(9):239–40.

Jamil S, Suhail SM. Group A meningococcal outbreak in Peshawar. J Postgrad Med Inst 1990;4(1):34–46.

Jamil S, Khan P, Rehman MU, Rizvi F. C-reactive protein; An indicator of complications in meningitis. J Postgrad Med Inst 1990;4(1):106–12.

Aminzadeh Z, Roudgari A. Jolt accentuation of headache in diagnosis of acute meningitis. Arch Clin Infect Dis 2010;5:106–9.

Ala A, Rahmani F, Abdollahi S, Parsian Z. Accuracy of neck stiffness, Kernig, Brudzinski, and jolt accentuation of headache signs in early detection of meningitis. Emerg (Tehran) 2018;6(1):e8.

Parrino TA. The physical examination can exclude the diagnosis of meningitis in low-risk adults. ACP J Club 2000;132(1):32.

Mofidi M, Negaresh N, Farsi D, Rezai M, Mahshidfar B, Abbasi S, et al. Jolt accentuation and its value as a sign in diagnosis of meningitis in patients with fever and headache. Turk J Emerg Med 2016;17(1):29–31.

Rasmussen HH, Sørensen HT, Møller-Petersen J, Mortensen FV, Nielsen B. Bacterial meningitis in elderly patients: clinical picture and course. Age Ageing 1992;21(3):216–20.

Attia J, Hatala R, Cook DJ, Wong JG. The rational clinical examination. Does this adult patient have acute meningitis? JAMA 1999;282(2):175–81.

Ward MA, Greenwood TM, Kumar DR, Mazza JJ, Yale SH. Josef Brudzinski and Vladimir Mikhailovich Kernig: signs for diagnosing meningitis. Clin Med Res 2010;8:13–7.

Morris G. Patients presenting as emergencies. In: Glynn M, Drake WM, editors. Hutchison’s Clinical Methods, 24th Edition. Elsevier, London. 2018; p.121–36.

Rosmarin C, Jawad A. Patients with a fever. In: Glynn M, Drake WM, editors. Hutchison’s Clinical Methods, 24th Edition. Elsevier, London. 2018; p.141–51.

Cleg G, Robertson C. The critically ill. In: Douglas G, Nicol F, Robertson C, edtiotrs. Macleod’s Clinical Examination, 13th Edition. Churchill-Livingstone Elsevier, London. 2013; p.422.

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Published

2022-01-01

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