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The classic signs of meningeal inflammation include nuchal rigidity and Kernig's and Brudzinski's signs, but how often can these maneuvers really help in diagnosis? Researchers prospectively evaluated the presence of these signs in adults who presented with symptoms of meningitis to a single emergency department during a 4-year period.
Of 297 patients who underwent lumbar puncture, 80 received a diagnosis of meningitis (i.e., ≥6 white blood cells/mL cerebrospinal fluid [CSF WBC]). Nuchal rigidity was present in 24 of 80 patients with meningitis and in 69 of 217 without disease, for a sensitivity of 30%, a specificity of 68%, and a positive predictive value of 26%. Kernig's sign had a sensitivity of 5%, a specificity of 95%, and a positive pr…