A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin and mucous membranes
- Functional testing of the cervical spine (due toDD. Pseudomeningism!).
- Auscultation (listening) of the heart.
- Auscultation of the lungs
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
- Inspection (viewing).
- Neurological examination – including testing of Brudzinski, Kernig and Lasègue sign.
The following neurological signs are prominent in meningismus:
Brudzinski sign
- This is “positive” when the patient spontaneously flexes hip/knee joints in the supine position with passive neck movement.
Kernig sign
- This is “positive” if in the patient in the supine position, the attempt to extend the leg from the posture bent on the abdomen leads to pain.
Lasègue sign
- This is “positive” when flexion of about 70-80° is not feasible due to pain in the leg, buttocks or back occurring beforehand. Some authors evaluate the Lasègue sign as positive already when the pain symptomatology starts at a flexion of 45° (reason: tension states in the back muscles can lead to a false positive test result beyond 45° (“pseudo-Lasègue).