Aseptic Meningitis

25 yo M with no PMHx presenting with headache, photophobia and nuchal rigidity. LP shows findingins consistent with aseptic meningitis. Here are a couple of papers that discuss meningitis, as ’tis the season.

If your students or attendings mention Kernig’s or Brudzinksi’s signs, please refer them to the paper below, which shows how poor they really are.

• Practice guidelines for the management of bacterial meningitis.(Clin Infect Dis.2004 Nov 1;39(9):1267-84. Epub 2004 Oct 6)

• The Diagnostic Accuracy of Kernig’s Sign, Brudzinski’s Sign, and Nuchal Rigidity in Adults with Suspected Meningitis (Clin Infect Dis. (2002) 35 (1): 46-52)

One major point to take home is that acute HIV can present as aseptic meningitis. We have a new HIV assay which includes both the ELISA and a p24 antigen, and this reduces the “window period” of HIV to only about 1 week!