# CNS: No meningeal signs



## suzannereed (Jan 24, 2011)

When my pediatrian documents under physical examination "no meningeal signs" do I give him credit under neurologic?  But for what element of examination, test cranial nerves with notation of any deficits, or examination of deep tendon reflexes with notation of pathological reflexes (e.g. Babinski), or examination of sensation (e.g. by touch, pin, vibration, proprioception).  I have searched on the Internet, but can't find a clear answer.  Can anyone help please?


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## Andrschery (Jan 26, 2011)

*CNS: No Meningeal Sigms*

Suzanne;

It would be nice if your physician would expand on his statement of no meningeal signs but here is what is being referred to and supposedly examined when checking for meningeal irritation.  Signs of meningeal irritation indicate inflammation of the dura; these signs are described below.

Nuchal rigidity or neck stiffness is tested by placing the examiner's hand under the patient's head and gently trying to flex the neck. Undue resistance implies diffuse irritation of the cervical nerve roots from meningeal inflammation.

The Brudzinski sign is flexion of both knees during the maneuver to test nuchal rigidity. This indicates diffuse meningeal irritation in the spinal nerve roots.

The Kernig sign is elicited by flexing the hip and knee on 1 side while the patient is supine, then extending the knee with the hip still flexed. Hamstring spasm results in pain in the posterior thigh muscle and difficulty with knee extension. With severe meningeal inflammation, the opposite knee may flex during the test.

The Lasègue or straight-leg raising (SLR) sign is elicited by passively flexing the hip with the knee straight while the patient is in the supine position. Limitation of flexion due to hamstring spasm and/or pain indicates local irritation of the lower lumbar nerve roots. Reverse SLR is elicited by passively hyperextending the hip with the knee straight while the patient is in the prone position. Limitation of extension due to spasm and/or pain in the anterior thigh muscles indicates local irritation of the upper lumbar-nerve roots.

With the above descriptions of the exam that is being performed I would say your MD's  blanket statement of "no meningeal signs" would be most appropriate in the reflex portion of a neurological exam.. and may even be appropriate if not used in neuro to use under musculoskeletal for the chin to chest exam portion.  But, I highly recommend educating your Physician to utilize more descriptive charting for meningeal examination.  

Hope this helps!!!

Cheryl Anderson, LPN, CPC, CEMC


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