A 50-year-old man with no significant medical history presents to the ED with a 2-day history of headache and fever. He also reports severe fatigue, diffuse myalgias, abdominal pain, diarrhea, nausea, and occasional vomiting. Initial examination shows no neck stiffness and negative Kernig's and Brudzinski's signs. Empiric antibiotic treatment with ceftriaxone and metronidazole is started for suspected abdominal infection. The patient rapidly develops hearing loss. On reassessment, marked neck stiffness is noted. Ceftriaxone is intensified, and amoxicillin and acyclovir are added to cover infectious meningitis. Lumbar puncture confirms Haemophilus influenzae meningitis. This article reviews the clinical signs of meningism and their diagnostic value.

一位没有重要病史的50岁男子因头痛和发热两天而前往急诊室就诊。他还报告了严重的疲劳、弥漫性肌痛、腹痛、腹泻、恶心以及偶尔呕吐的症状。初步检查未发现颈部僵硬，Kernig征和Brudzinski征均为阴性。鉴于疑似腹部感染，开始使用头孢曲松和甲硝唑进行经验性抗生素治疗。患者迅速出现听力下降。在重新评估时，注意到明显的颈部僵直。将头孢曲松加强，并添加阿莫西林和aciclovir以覆盖感染性脑膜炎。腰椎穿刺确认为流感嗜血杆菌脑膜炎。本文回顾了脑膜刺激征的临床表现及其诊断价值。