Question:
I was mis-diagnosed by an ambulance crew as having flu. But when I recovered I read up on meningitis and discovered Kernig's sign, which was a position I was desperate to stay in. are ambulance crews overly focused on rashes and photosensitivity (neither of which I had) to the exclusion of the kernig's sign or are they still better diagnostic indicators?
Answer:
Professor Adam Finn says:
A sign in medicine is something you find when you examine the patient (as opposed to a symptom which is an experience the patient describes to you when you ask them about their condition, like headache). Signs in meningitis can include certain typical positions the patient adopts - the most typical is stiffness of the neck so that he or she cannot move the head fully forward. In order to show this sign you might have to try and move the patient's head forward with your hands in order to show whether the normal range of movement was not present. In more severe cases the patient may show "opisthotonus" in which the whole spine is bowed backwards and the head and legs as well.
Kernig was a German neurologist who lived during the nineteenth century. He showed that patients with meningitis sometimes experience pain and restricted movement if you try and straighten out their leg at the knee from a position where it is bent at the hip and knee. So the sign is not so much a position as a test you can perform which, when positive, would make you more suspicious of meningitis.
Meningitis often starts with a ‘flu-like illness so this can certainly be misleading. A rash which does not go away when pressed can be an important sign of blood stream infection, a serious infection caused by some of the bacteria that can also cause meningitis. Although blood stream infection and meningitis sometimes happen at the same time, it's quite common to have meningitis alone without the rash. Photophobia - a dislike of light in your eyes - is another symptom of meningitis but it is not always present.
One of the big problems with meningitis is that there aren't any symptoms and signs that are always there so there's no easy or perfect way to diagnose it. This is a particular problem in children who can't tell you how they feel and who commonly don't have any of the well known signs until quite late on in the illness when it is getting late to start antibiotics.
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