Abstract
Acute meningitis is a medical emergency and its accurate diagnosis could help physicians to accelerate treatment and reduce the mortality and morbidity of patients. Jolt accentuation of headache (Jolt) is an easy clinical maneuver that can be used to diagnose meningitis, but its diagnostic accuracy is controversial. We aimed to assess the "Jolt maneuver" in diagnosis of suspected acute meningitis patients admitted to the emergency ward of Imam-Khomeini Hospital Complex in Tehran, Iran. Out of 250 patients, 227 were included and 64 (28.2%) had cerebrospinal fluid (CSF) changes compatible with meningitis. Jolt was positive in 40 of 64 (62.5%) meningitis patients. Sensitivity, specificity, positive and negative likelihood ratio (+ LR and - LR) of Jolt were 62.5, 88.3%, 5.36 and 0.42, respectively. These indices were also compared to nuchal rigidity, Kernig's and Brudzinski's signs. The highest + LR was for Kernig's sign (6.79) and the lowest - LR was for nuchal rigidity (0.39). CSF culture was positive in two patients (Streptococcus pneumoniae and Aspergillus sp.). We found that in adult patients with fever and acute headache, a positive Jolt maneuver has a good diagnostic accuracy for diagnosis of meningitis and indicates a need ...Continue Reading
References
Mar 1, 1991·Headache·T Uchihara, H Tsukagoshi
Oct 30, 1982·British Medical Journal·J N Blau
Dec 14, 2001·The New England Journal of Medicine·R HasbunV J Quagliarello
Jun 13, 2002·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Karen E ThomasVincent J Quagliarello
Nov 9, 2002·The Journal of Infectious Diseases·W Michael ScheldHans-Walter Pfister
May 2, 2007·Current Opinion in Infectious Diseases·Bonita E Lee, H Dele Davies
Jul 9, 2010·Clinical Microbiology Reviews·Matthijs C BrouwerDiederik van de Beek
Jul 10, 2010·Clinical Neurology and Neurosurgery·Swati WaghdhareShriprakash Kalantri
Sep 28, 2013·The American Journal of Emergency Medicine·Hidetaka TamuneMitsuhiro Nakamura
Oct 22, 2013·The American Journal of Emergency Medicine·Jolene H NakaoDavid H Newman
Mar 13, 2014·The American Journal of Emergency Medicine·Hidetaka Tamune, Takaie Kuki
Mar 25, 2014·The American Journal of Emergency Medicine·Toshiki Uchihara
Jan 6, 2017·Headache·Ryota SatoSarah Kyuragi Luthe
Citations
Sep 5, 2018·Headache·Hidetaka TamuneToshiki Uchihara
Sep 3, 2019·Rinshō shinkeigaku = Clinical neurology·Daisuke KuzumeMasahiro Yamasaki
Jun 12, 2020·The Cochrane Database of Systematic Reviews·Masahiro IguchiHiraku Tsujimoto
Sep 14, 2019·Journal of General and Family Medicine·Tetsuya AkaishiTadashi Ishii