meningismus definition

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meningismus definition

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Test your vocabulary with our 10-question quiz! Chronic meningitis has similar symptoms as acute meningitis, but develops over a couple of weeks. If you or your child has been around someone who has bacterial meningitis, ask your doctor what steps you should take to avoid catching it. The inflammation from meningitis typically triggers symptoms such as headache, fever and a stiff neck. The patient also endorsed nasal congestion and several episodes of palpitations over the few months prior to presentation but denied photophobia, On examination, his temperature was 102.9[degrees] F (39.4[degrees] C), and he had, Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content, Transfusion-related transmission of yellow fever vaccine virus--California, 2009. MND is an author of a number of references cited in this topic. Examination can be normal or may reveal altered consciousness, meningismus, intraocular hemorrhages, or focal findings. Patients may also display features of opisthotonus in which the whole body undergoes spasm that leads to bending back of the legs and head and bowing forward of the body. Need even more definitions? What is Flynn criteria for Nonunion lateral humerus condyle? mus ˌmen-ən-ˈjiz-məs plural meningismi -ˌmī : a state of meningeal irritation with symptoms suggesting meningitis that often occurs at the onset of acute febrile diseases especially in children Dictionary Entries Near meningismus meningism meningismus meningitic See More Nearby Entries Cite this Entry Style "Meningismus." Children with fever and signs of meningitis or encephalitis (eg, meningismus and/or altered mental status) may present with . Epub 2011 May 5. It can be life-threatening or lead to brain damage unless you get quick treatment. It may result from infections, other disorders, or reactions to drugs. Learn how it can…, There are important differences between viral, fungal, and bacterial meningitis, in terms of their severity, how common they are, and the way they are…. Meningismus is characterized by the signs and symptoms of nuchal rigidity (neck stiffness), photophobia (sensitivity to bright light), and headache. Meningitis symptoms can develop within hours or days and may include: In infants, meningitis symptoms may include: Anyone can get meningitis, but research shows that it's more common in these age groups: Meningitis is more of a danger for people with certain medical conditions, such as a damaged or missing spleen, long-term disease, or immune system disorders. Title: Grade 4 Meningismus, CTCAE Definition: Life-threatening consequences; urgent intervention indicated . Less common causes of meningitis include: Your doctor will ask about your medical history and do a physical exam, including checking your neck for stiffness and looking for a skin rash that might suggest a bacterial infection. N Engl J Med. Last medically reviewed on March 13, 2018. The sign is positive if hamstring spasm results in pain in the posterior thigh and difficulty with knee extension. C. Meningismus Meningismus is a classification of signs and symptoms that is comparable to meningitis (e.g. Your Guide to Salmonella Meningitis and How to Spot It. Meningismis the clinical syndrome of headache, neck stiffness, and photophobia, often with nausea and vomiting.1It is most often caused by inflammation of the meninges (see later), but other causes include raised intracranial pressure. These examples are programmatically compiled from various online sources to illustrate current usage of the word 'meningitis.' Other symptoms can also include visual blurring, tinnitus (ringing or buzzing sound in the ears) and vertigo. accept these cookies in order to log into the site. Viral meningitis is more common than the bacterial form and generally -- but not always -- is less serious. ([dagger]) In the 30 days after blood product transfusion (e.g., fever, rigors, headache. The site is secure. The inflammation is usually caused by infection of the fluid surrounding the brain and spinal cord. Meaning of Meningismus in the German dictionary with examples of use. Overview One of the physically demonstrable symptoms of meningitis is Kernig's sign. There are many causes of xanthochromia such as acute intracerebral hemorrhage, brain tumors, infection, increased protein, and severe systemic jaundice. The most common ones in the U.S. are: A bacteria called Haemophilus influenzae type b (Hib) was a common cause of meningitis in babies and young children until the Hib vaccine became available for infants. Neurologic complaints were visual disturbances, 25 patients (51%); headache, 16 (32%); gait difficulty, two (4%); hearing loss, two (4%); Signs and symptoms of this include decreased level of consciousness, headache, neck pain, There was no regional adenopathy or evidence of. and transmitted securely. Recurrent meningitis is a rare condition that happens when meningitis goes away and comes back again. This site needs JavaScript to work properly. Curr Pain Headache Rep. 2014 Mar;18(3):401. doi: 10.1007/s11916-013-0401-4. Epub 2016 Aug 24. Meningism or meningismus is a morbid state characterized by a meningitic syndrome (a triad of headache, photophobia and nuchal rigidity) without intracranial inflammation. Please enable it to take advantage of the complete set of features! Your doctor might tell you to stay in bed, drink plenty of fluids, and take over-the-counter pain medicines if you have a fever or aches. When 'thingamajig' and 'thingamabob' just won't do, A simple way to keep them apart. Meningism is a set of symptoms similar to those of meningitis but not caused by meningitis. In most cases, doctors can treat the underlying cause of meningismus and cure patients of their afflictions. Because certain germs that cause meningitis can spread easily, outbreaks are most likely to happen in places where people live close to each other. These membranes are called meninges. There are additional signs and symptoms to look out for if you suspect you have meningitis. Cerebral angiography confirms the presence of aneurysms. Nglish: Translation of meningitis for Spanish Speakers, Britannica English: Translation of meningitis for Arabic Speakers, Britannica.com: Encyclopedia article about meningitis. Infections and other disorders affecting the brain and spinal cord can activate the immune system, which leads to inflammation. Disclaimer. As the leg as straightened, it causes leg pain. It's an extremely serious illness. Meningitis is inflammation of the meninges and subarachnoid space. Test your vocabulary with our 10-question quiz! This amoeba lives in soil or warm, fresh water, but not salt water. Pediatrics. 2023. Most patients, including young children, will recover from the underlying cause and get better. In Brudzinski’s Sign, when the neck is flexed, it causes flexion of the hips and knees. We avoid using tertiary references. TheFreeDictionary meningeal sign meningeal sign A clinical sign of meningeal irritation: (1) Brudzinski signs (chin to chest evokes hip flexion); (2) Kernig sign (resistance to knee extension evokes pain in hamstrings); (3) Nuchal rigidity. Other related clinical signs include Kernig's sign and Brudzinski's sign. Some authors, have also used the term “meningism” or “meningismus” to describe the characteristic signs of meningitis, which may be present in conditions other than meningitis. Terms and conditions  Comment policy  Cookies and Privacy policy  Sitemap  Youtube. Meningeal signs in both cases are ignored or not examined, and the neurologic status is considered normal. A positive Brudzinski sign occurs when this causes flexion of the hips. The cheek sign may be present, in which exertion of pressure on the cheek below the zygoma may lead to forearm rising and flexion. Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees. See additional information. MeSH Duprés's syndrome (70784009); Meningismus (70784009); Meningism (437986008); Meningeal irritation (70784009) Definition The triad of nuchal rigidity, photophobia and headache. 2016 Oct;1(2):114-121. doi: 10.1016/S2468-1253(16)30038-3. Examination can be normal or may reveal altered consciousness, meningismus, intraocular hemorrhages, or focal findings. Send us feedback about these examples. Non-infectious meningitis is caused by diseases like lupus or cancer, or if you’ve had a head injury, brain surgery, or take certain medications. Severity and acuity vary. Other diagnostic tools include CT imaging and blood cultures. official website and that any information you provide is encrypted Symptoms of meningitis may include behavioral or mental status changes, fever, vomiting. Other symptoms include headache, stiff neck, vomiting, and dizziness. Brudzinski’s neck sign is positive when the patient, while lying supine, involuntarily lifts the legs when examiner attempts to lift the patient’s head off the examining couch. This information should not be considered complete, up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical, or any other professional. FOIA Computed tomography (CT) indicated if subarachnoid hemorrhage is clinically suspected. Individuals displaying symptoms of this syndrome should be taken to the hospital as soon as possible. Doctors often treat the underlying causes of the disease and focus on reducing intracranial pressure. Otherwise, an untreated bout of meningismus means the underlying cause is worsening and becoming more severe.  In Kernig’s Sign, the patient is supine with the knee bent at right angles. You or your child will need to get medical help right away. The doctor might give you a general, or broad-spectrum, antibiotic even before they’ve found the exact bacteria that caused your illness. Headache Diagnosis in Children and Adolescents. Early and definitive detection is extremely important in the treatment of this condition. However, it does not substitutes a physician, hospital or medical care facility. Antifungal medications can treat fungal meningitis. Etiology Bilirubin is the byproduct of the degradation of oxyhemoglobin by the enzyme oxygenase. Learn a new word every day. Subscribe to America's largest dictionary and get thousands more definitions and advanced search—ad free! Unable to load your collection due to an error, Unable to load your delegates due to an error. To save this word, you'll need to log in. Computed tomography (CT) indicated if subarachnoid . Mehndiratta M, et al. We can see you’re on your way to BMJ Best Practice for, Do you want to go to BMJ Best Practice for, No, I’d like to continue to BMJ Best Practice for, unilateral or bilateral sixth cranial nerve palsies, autosomal dominant polycystic kidney disease (ADPKD). VA declares that he has no competing interests. (Most of the time.). A prospective study in March 1991 looked at 54 patients with fever and a headache. Delivered to your inbox! What causes meningitis? Swift identification of the root cause and immediate treatment of the symptoms is the best course of action to ensure patient safety. | Designed and Developed by, Meningismus Symptoms, Causes, Signs, Test, Treatment. Three-year multicenter surveillance of pneumococcal meningitis in children: Clinical characteristics, and outcome related to penicillin susceptibility and dexamethasone use. These tests have good specificity, but poor sensitivity. These infections are passed to others when you cough, sneeze, kiss, or share toothbrushes or eating utensils. [PRIMARY HEADACHE IN CHILDREN AND ADOLESCENTS--DIAGNOSIS AND TREATMENT]. [ PubMed] [ Google Scholar] Baraff LJ, Lee SI, Schriger DL. Spinal fluid pressure may be elevated but spinal fluid is normal. Meningitis is a rare infection that affects the delicate membranes -- called meninges -- that cover the brain and spinal cord. ??accessibility.screen-reader.external-link_en_US?? Meningismus can result from infection (usually influenza, pneumonia, measles, scarlet fever, typhus and typhoid fever), poisoning (coma, diabetes, uremia, food poisoning, and occupational poisoning), brain injury after a lumbar puncture endolumbalno introduction of medicinal substances, with hypertension and others. Dr Salah Keyrouz would like to gratefully acknowledge Dr Michael N. Diringer, a previous contributor to this topic. Accessed 6 Jun. Klinik bulgulari uykuya egilim, huzursuzluk, Clinical neurological and orthopaedic council examinations revealed a painful loss of mobility (rotation and lateral bending) in the cervical spine, tenderness on palpation around the cervical spine, fever (39.5[degrees]C), an intact sensorium in the head and neck region and the upper extremities, no, This case report illustrates an unusual clinical presentations of PA: the patient had pupil-sparing CN III palsy, which is more characteristic of ischemic rather than compressive causes; CN IV palsy is not common in PA cases; and altered LOC in PA patients is usually associated with headache [24], nausea, vomiting, signs of, * The meningitis phase is characterized by pronounced neurologic features such as, TBE serology resultsf First serum IgM positive, IgM positive, IgG sample IgG positive negative Convalescent- IgM positive, IgM positive, IgG phase serum IgG 10-fold seroconversion sample increase Variable Case-patient 3 Case-patient 4 Destination Sweden Russia Probable area Northwest of Southwestern of exposure Stockholm Siberia Month of travel 2011 May-Aug 2010 Aug Duration of 107 17 travel, d Duration of Undetermined 17 probable exposure to tick habitat Recorded tick No No bite Neurologic, Examination of the cranial nerves, motor tone, strength, coordination, and gait were normal and there was no sign of, She was admitted to the hospital, where she was febrile to 102.9[degrees]F (39.4[degrees]C) and had, Powassan virus 1-4 weeks Generalized weakness, fever, disease or headache, vomiting progresses to encephalitis meningoencephalitis & may include (Powassan, Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content, Community acquired Klebsiella pneumoniae meningitis: a case report, Sarsilmis Bebek Sendromu Bulgulari Varliginda Aile Gorusmesinin Onemi/The Importance of Family Interview for Shaken Baby Syndrome, Extensive Craniocervical Abscess after Transoral Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion for Atypical Trigeminal Neuralgia: Report of a Severely Complicated Case, Pituitary Apoplexy Presenting as Ophthalmoplegia and Altered Level of Consciousness without Headache, The First Case Report of West Nile Virus-Induced Acute Flaccid Quadriplegia in Canada, Atypical Kawasaki Disease Presenting with Hemiparesis and Aphasia: A Case Report, Travel-related tick-borne encephalitis, Israel, 2006-2014, New Onset Insomnia in a Pediatric Patient: A Case of Anti-NMDA Receptor Encephalitis, Lymphocytic choriomeningitis virus meningoencephalitis from a household rodent infestation--Minnesota, 2015, Tickborne coinfections in the United States, Meningitis and Vaccine Preventable Diseases Branch. Meningismus, in general, comes with a positive prognosis. Due to the presence of phenomena edema and swelling of the brain and its meninges recommended intravenous infusion of hypertonic solutions, intramuscularly – novoryt, Mercosul, inside – 3% solution amidopirina. To save this word, you'll need to log in. This suggested that meningismus is the major clinical syndrome in chronic tension-type headaches in children and adolescents. Bookshelf The https:// ensures that you are connecting to the DOI: mayoclinic.org/diseases-conditions/meningitis/diagnosis-treatment/drc-20350514, ncbi.nlm.nih.gov/pmc/articles/PMC3548367/, Bacterial, Viral, and Fungal Meningitis: Learn the Difference, Bacterial Meningitis: Causes and How It’s Spread, Recurrent Meningitis: A Rare but Serious Condition, Understanding the Meningitis Vaccine: What It Is and When You Need It. Take these steps to prevent infections: Shmaefsky, B. Meningitis (Deadly Diseases and Epidemics), 2004. Bacterial meningitis is a serious disease that can lead to paralysis, stroke, and even death. You can’t pass on this type of meningitis to other people. Read more on how to treat and prevent it. Association between functional gastrointestinal disorders and migraine in children and adolescents: a case-control study. Meningismus - Meningismus is another important subset of neck stiffness that defines neck stiffness in association with meningeal irritation. The risk is higher with raw or undercooked foods. Meningismus definition: Meningism without the presence of infection or inflammation. Meningitis refers to the inflammation of leptomeninges and underlying subarachnoid cerebrospinal fluid (CSF). PM declares that he has no competing interests. People typically get it from swimming in water where the amoeba lives, not drinking it. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. 2006 Jan 26;354(4):387-96. http://www.ncbi.nlm.nih.gov/pubmed/16436770?tool=bestpractice.com, Cerebral and cervical arteriovenous malformation (AVM), ACR Appropriateness Criteria®: cerebrovascular diseases - aneurysm, vascular malformation, and subarachnoid hemorrhage. Epub 2014 Feb 12. Meningism, also called meningismus or pseudo meningitis is a set of symptoms similar to those of meningitis but not caused by meningitis. Rosen's Emergency Medicine and Mettler: Essentials of Radiology add the following indications for imaging in headache: signs and symptoms of elevated intracranial pressure (eg, papilledema); Straight leg raise did not elicit radicular pain, and she exhibited no, His condition was septic, with clinical symptoms of. Meningismus is characterized by the signs and symptoms of nuchal rigidity (neck stiffness), photophobia (sensitivity to bright light), and headache. National Library of Medicine 2. The bacteria that cause meningitis can spread when people who are infected cough or sneeze. Other symptoms include headache, stiff neck, vomiting, and dizziness. Required fields are marked *. Experts recommend that all children get them, as well as all adults who are at a higher risk for the disease. It results from infections with a fungus or the mycobacteria that cause tuberculosis. Evaluation of dizziness and vertigo in children and adolescents. Subscribe to America's largest dictionary and get thousands more definitions and advanced search—ad free! An official website of the United States government. . Diagnostic lumbar puncture in adults: animated demonstration, Tracheal intubation: animated demonstration, Use of this content is subject to our disclaimer, We can see you’re on your way to BMJ Best Practice forUnited States. This region is at high-risk of epidemics of both meningococcal and pneumococcal, Anywhere from one to five in 100 people who contract polio can develop, In some individuals, severe illness including, No other staffers or students have reported bacterial, Gathard, who was previously married to Chris Murdock, said she was told that early results of a medical examination suggested that her biological daughter had spinal, In 1961, Bradford’s youngest son, Billy, died of spinal, Post the Definition of meningitis to Facebook, Share the Definition of meningitis on Twitter, Palter, Dissemble, and Other Words for Lying, Skunk, Bayou, and Other Words with Native American Origins, Words For Things You Didn't Know Have Names, Vol. Meningism. So here’s what you need to know: If you feel either resistance or pain, see a doctor right away for treatment. Your feedback has been submitted successfully. PMID: 16901450 DOI: 10.1177/08830738060210050601 Abstract At present, both migraine and tension-type headaches in children are believed to be chronic primary headaches. Initial stabilization followed by surgical clipping or endovascular coil embolization is standard therapy. Before A condition characterized by neck stiffness, headache, and other symptoms suggestive of meningeal irritation, but without actual inflammation of the meninges (MENINGITIS). 2. Meningismus refers to these symptoms occurring without infection or inflammation of the meninges. Synonyms for Meningismus and translation of Meningismus to 25 languages. This is the first study that focuses on meningeal signs in children with chronic headaches. Introduction. Do you want to go to BMJ Best Practice for Australiainstead? There is a possibility of being hospitalized if you are dehydrated or have severe symptoms. Semantic Type: Finding Semantic ID: T033 Concept ID: C4553736 ID: 1641922 4. The sudden increase in intracranial pressure, as well as the destructive and toxic effects of blood on brain parenchyma and cerebral vessels, accounts for most complications. It isn’t contagious. Please always ask your doctor for personalized diagnosis, evaluation, assessment, treatment and care management plan. Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Neurol Neurochir Pol. Other related clinical signs include Kernig’s sign and Brudzinski’s sign. Conus Medullaris Syndrome vs Cauda Equina Syndrome : Anatomical basis and Mnemonic, Handtevy Method : Emergency Drug Dose by Age, Total Contact Cast (TCC) – Principles and Technique, Injection technique for De Quervain’s Tenosynovitis, A case of child with Mucopolysaccharidosis : Hunter Syndrome, Ectrodactyly or Lobster-claw syndrome : A Case Report, A Case of Neonatal Umbilical Infection leading to Septic Shock, Partial Exchange transfusion for Neonate with Polycythemia. Most cases of meningitis in the United States are caused by a viral infection. We also use cookies for statistics and to analyse site usage. Learn how your comment data is processed. Kernig’s sign, the Brudzinski sign, and nuchal rigidity are typically not successful at diagnosing those with meningitis. Kernig’s sign is said to be positive when the thigh is flexed at the hip and knee at 90 degree angles, and subsequent knee extension is painful (giving rise to resistance). Meningism is the clinical syndrome of headache, neck stiffness and photophobia, often with nausea and vomiting. Fungal meningitis is much less common than the bacterial or viral forms. You can learn more about how we ensure our content is accurate and current by reading our. Title: Meningismus, CTCAE Definition: A disorder characterized by neck stiffness, headache, and photophobia resulting from irritation of the cerebral meninges. For many patients, a battery of antibiotics will work wonders for their condition. Meningismus in children with chronic headache is most likely due to streptococcal infection. government site. Similar to Kernig’s sign, research has shown that many people with meningitis don’t have the Brudzinski sign or nuchal rigidity. [Photosensitivity in children with idiopathic headaches]. Merriam-Webster unabridged You might also get corticosteroids to ease inflammation. Chronic mild sterile (possibly autoimmune) inflammation of meninges (dura mater) can be caused by a preceding infection, as well as minor trauma of the head and/or back. Flex the hip and knee on one side while the patient is supine. Their use or mentioning on this website is only for informational purposes. Surviving Meningitis: Carl Buher’s Story, Meningitis (Bacterial, Viral, and Fungal), Meningitis: 12 FAQs About Prevention, Symptoms & Treatment, Crying that’s constant and gets louder when you hold the. Post the Definition of meningismus to Facebook, Share the Definition of meningismus on Twitter, Palter, Dissemble, and Other Words for Lying, Skunk, Bayou, and Other Words with Native American Origins, Words For Things You Didn't Know Have Names, Vol. Relax the neck muscles by bringing the supine patient to the edge of the bed and allow the head to hang outside the bed for a few seconds. The cause of meningism can be increased intracranial pressure, brain edema (with traumatic brain injury, coma, and uremia). Le Gal J, Michel JF, Rinaldi VE, Spiri D, Moretti R, Bettati D, Romanello S, Berlese P, Lualdi R, Boizeau P, Viala J, Bellaiche M, Zuccotti GV, Crichiutti G, Alberti C, Titomanlio L. Lancet Gastroenterol Hepatol. Nuchal rigidity is the inability to perform the . Meningitis is a life threatening medical emergency characterized by the inflammation of the membranes surrounding your spinal cord and brain. All rights reserved. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Accessed 6 Jun. We also share information about the use of the site with our social media, advertising and analytics partners. Note: Would you like email updates of new search results? Now, flex the patient’s head with the hand behind the head, while your hand on chest restrains the patient and prevents him/her from rising. Nuchal rigidity is the inability to perform the neck flexion forward due to rigidity of neck muscles. Other symptoms can also include visual blurring, tinnitus (ringing or buzzing sound in the ears) and vertigo. Some meningeal signs were found in 12% of 1007 children suffering from migraine, whereas 97% of 731 children with tension-type headaches had the whole set of meningeal signs. When a cerebral aneurysm ruptures, blood flows into the subarachnoid space, sometimes seeping into brain parenchyma and/or ventricles. You’re more likely to get this form of meningitis if you have a problem with your immune system, like AIDS. Meningism, also called meningismus or pseudo meningitis is a set of symptoms similar to those of meningitis but not caused by meningitis. Once they do, they’ll change to a drug that targets the specific bacteria they find with the spinal tap. SAH is bleeding into the subarachnoid space and is an emergency. Prompt diagnosis and treatment of meningitis is. N Engl J Med. 1998;102:1087. Several kinds of bacteria can cause bacterial meningitis. Practical Procedures : Lumbar Puncture (LP), https://epomedicine.com/clinical-medicine/cns-examination-meningeal-signs/. Subarachnoid hemorrhage (SAH) presents as a sudden severe headache, often described as "the worst headache of life," with nausea, vomiting, and photophobia. Meningism or meningismus is a morbid state characterized by a meningitic syndrome (a triad of headache, photophobia and nuchal rigidity) without intracranial inflammation. …stabilization as discussed separately. 2006 Jan 26;354(4):387-96. Meningismus is a common finding but is non-specific. Department of Neurology and Rehabilitation. J Headache Pain. Complications are common and include rebleeding, acute hydrocephalus, and delayed cerebral ischemia. Aneurysmal subarachnoid hemorrhage. Save my name, email, and website in this browser for the next time I comment. Amoebic meningitis is a rare, usually fatal infection by a single-celled bug called Naegleria fowleri. In general, alterations in consciousness such as somnolence and behavioral disturbances predominate early in . When 'thingamajig' and 'thingamabob' just won't do, A simple way to keep them apart. Curr Pain Headache Rep. 2016 Jan;20(1):7. doi: 10.1007/s11916-015-0537-5. Transmission of streptococcus equi subspecies zooepidemicus infection from horses to humans, Symptomatic early neurosyphilis among HIV-positive men who have sex with men--four Cities, United States, January 2002-June 2004, Haemophilus Influenzae Type B Disease, Vaccines, and Care of Exposed Individuals, Fatal influenza A(H1N1)pdm09 encephalopathy in immunocompetent man, A 52-year-old woman with headache and bradycardia, meningococcal polysaccharide diphtheria toxoid conjugate vaccine, Meningitis and Vaccine Preventable Diseases Branch. Delivered to your inbox! Healthline Media does not provide medical advice, diagnosis, or treatment. specifically : a disease marked by inflammation of the meninges that is either a relatively mild illness caused by a virus (such as various Coxsackieviruses) or a more severe usually life-threatening illness caused by a bacterium (especially the meningococcus, Neisseria meningitides, or the serotype designated B of Haemophilus influenzae)

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meningismus definition

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