Meningism

Marian Grosser studied human medicine in Munich. In addition, the doctor, who was interested in many things, dared to make some exciting detours: studying philosophy and art history, working on the radio and, finally, also for a Netdoctor.

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Meningism is a painful stiff neck that occurs primarily in diseases of the meninges. Those affected can no longer actively bend their head towards the chest because pain and tension in the neck muscles prevent this. In a broader sense, meningism also includes other complaints such as nausea and photophobia. Read here what causes meningism to develop and why you need to see a doctor immediately.

Meningism: description

Patients with meningism experience pain in the head and neck area when they try to bend their head toward the sternum. So they avoid this movement. In addition, the neck muscles tense in response to the pain, which makes it even more difficult to bend the head. This creates the impression of neck stiffness, although neither the cervical vertebrae nor the neck muscles are impaired. Correspondingly, the neck stiffness disappears with deep unconsciousness.

The term meningism goes back to the medical term "meninges" for meninges. The cause of the pain in meningism is usually an irritation or disease of the meninges.

The stiff neck is then often not the only symptom. Typically, the patients also suffer from headaches, nausea and an increased sensitivity to light and noise (photophobia or phonophobia). These complaints are also summarized under the term "meningeal syndrome".

How does meningism cause pain?

There are three meninges that lie on top of each other like layers and surround the entire brain and spinal cord. The inner (pia mater) and middle (arachnoid) skin are also referred to as soft meninges, the outer (dura mater) as hard meninges. They have a protective function and also play an important role in blood flow and nutrient supply.

The outer meninges in particular are very sensitive to pain. If the meninges are irritated, it is responsible for sometimes severe headaches. If the patient bends his head forward, this exerts a slight pull on the meninges. This intensifies any pain that is already present in the head and neck area. If a disease of the meninges is still at an early stage or if the meninges are only slightly irritated, there may be no pain (yet) at rest. It is then only triggered when the head is bent.

Meningism: causes and possible diseases

Classically, meningism occurs with meningitis (meningitis), often as the first symptom. Such inflammation of the meninges is usually triggered by certain bacteria or viruses, more rarely fungi or parasites. Not every meningitis is necessarily accompanied by meningism. For example, sick newborns often lack neck stiffness.

In addition to inflammation caused by pathogens, there are a few other triggers that can cause irritation of the meninges and subsequently meningism. This includes:

Subarachnoid haemorrhage: A type of stroke that causes bleeding between the inner and middle meninges. The main symptom is a sudden, very severe headache.
Meningeosis neoplastica: settlement of tumor cells in the soft meninges; can occur in the late stages of various cancers.
Sinus thrombosis: blood clots in the large blood drains (sinuses) of the brain. These are located in the hard meninges.
Sepsis ("blood poisoning"): Spread of bacteria or fungi from a focus of inflammation into the entire bloodstream and as a result of various organs (such as the meninges).
Sunstroke: Inflammatory reaction of the meninges due to prolonged exposure to direct sunlight on the head and neck.
Lead poisoning: Possible consequences include cramps and inflammation of the cerebral vessels (lead encephalopathy). Over time, this sometimes leads to irritation of the meninges.

Pseudomeningism

If painful neck stiffness is not caused by irritated meninges but by other factors, it is referred to as pseudomeningism. The causes of such neck flexion pain include, for example, fractures, herniated discs or signs of wear and tear (osteoarthritis) in the cervical spine. Migraines or tumors can also lead to pseudomeningism.

Meningism: when do you need to see a doctor?

Meningism is an emergency and almost always indicates a serious condition. Regardless of possible other symptoms, those affected should therefore go to an emergency room or call the emergency doctor as soon as possible.

In the case of pseudomeningism, additional symptoms such as nausea or sensitivity to light are usually absent. But this can also be absent with meningism, so that you should always see a doctor, especially if you suddenly experience a stiff neck.

Meningism: what does the doctor do?

If meningism is suspected, the doctor first asks the patient whether there are any other symptoms besides the stiff neck. If there are other causes behind the stiff neck, there may be indications of this in the patient consultation.

During the examination, the doctor bends the patient's head forward while the patient lies on his back. He pays attention to whether the head flexion is difficult and whether the patient reports pain - evidence of meningism.

There are also other signs of meningism that the doctor can check: the so-called nerve stretching signs. Using certain maneuvers, he stretches the patient's meninges, which leads to pain. Signs of nerve stretching include:

Lasègue sign: the doctor lifts the patient's stretched leg up. If the meninges are irritated, this can lead to pain in the leg, buttocks or back from a certain degree of flexion.
Kernig's sign: The patient is lying on his back with his leg flexed at the hip and knee. The doctor now slowly extends the leg in the knee joint, with the same pain as with the Lasègue sign.
Brudzinski's sign: Again the patient lies on his back. The doctor bends his head forward, whereupon the patient reflexively draws his legs to avoid pain.

One speaks of nerve stretching signs because during these test maneuvers pain not only occurs with meningism, but also when nerve roots on the spinal cord are irritated. The neck stiffness is then usually missing.

If the suspicion of meningism is confirmed, the cause must be found with the help of additional examinations. The faster this succeeds, the sooner the right therapy can be started.

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