[Signs of meningism: true clues or false pretenses ?]

A 50-year-old man with no significant medical history presents to the ED with a 2-day history of headache and fever. He also reports severe fatigue, diffuse myalgias, abdominal pain, diarrhea, nausea, and occasional vomiting. Initial examination shows no neck stiffness and negative Kernig's and Brudzinski's signs. Empiric antibiotic treatment with ceftriaxone and metronidazole is started for suspected abdominal infection. The patient rapidly develops hearing loss. On reassessment, marked neck stiffness is noted. Ceftriaxone is intensified, and amoxicillin and acyclovir are added to cover infectious meningitis. Lumbar puncture confirms Haemophilus influenzae meningitis. This article reviews the clinical signs of meningism and their diagnostic value.