From Brudzinski to Jamil: Unveiling Classical and Emerging Clinical Signs of Meningitis

TL;DR

This review discusses classical and emerging physical signs for diagnosing meningitis, emphasizing their importance in clinical decision-making, especially in resource-limited settings.

Contribution

The paper highlights emerging signs like Jamil’s sign and emphasizes the value of combining multiple physical signs for improved meningitis detection.

Findings

Classic signs like Kernig’s and Brudzinski’s have variable sensitivity and cannot confirm meningitis alone.

Emerging signs such as Jamil’s sign offer potential for detecting subtle meningeal irritation.

Combining multiple physical signs with clinical judgment improves diagnostic accuracy in meningitis.

Abstract

Meningitis can result from bacterial, viral, fungal, or noninfectious causes and requires early recognition to reduce both death and long-term complications. While laboratory testing and imaging confirm the diagnosis, bedside examination remains pivotal in guiding initial clinical decisions. This narrative review summarizes the main clinical signs of meningitis, both classical and more recently described, and discusses their diagnostic value. A structured literature search was conducted across major medical databases and sources, focusing on physical signs rather than laboratory or imaging approaches. Classic signs such as Kernig’s and Brudzinski’s are well recognized but limited by variable sensitivity. Other bedside maneuvers, including jolt accentuation and less commonly used signs, provide additional diagnostic context. Emerging signs, such as Jamil’s sign, highlight the potential for improved detection of subtle meningeal irritation. Although no single sign can confirm or exclude meningitis with certainty, combining several findings with careful clinical judgment enhances diagnostic accuracy. In resource limited settings, bedside signs remain especially critical where access to imaging and laboratory confirmation may be delayed. Training clinicians in the correct interpretation and performance of these signs, and incorporating these into practice, can improve patient outcomes while strengthening early diagnosis. Future work should continue to validate emerging signs across diverse populations and encourage uniform examination protocols.