• The classic triad of fever, meningismus (stiff neck), and altered mental status only occurs in 44% of cases of acute bacterial meningitis (ABM).

 

• Headache is a much more common presenting complaint with ABM.

 

• The sensitivity and specificity of Kernig and Brudzinski signs are suboptimal, making their presence or absence of little diagnostic value.

References

• Van de Beck, D, et al.  "Clinical features and prognostic factors in adults with bacterial meningitis."  New England Journal of Medicine. 2004; 351 (18); 1849-59.

 

• Thomas KE, et al.  "The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis."  Clinical Infectious Diseases.  2002; 35(1); 46-52.