Jolt accentuation test to rule-out meningitis
Posted by dkwinter

"On the other hand, the jolt accentuation test is an excellent maneuver to help rule out meningitis in a low-risk, nontoxic patient with headache and fever.7,11The patient rotates his or her head horizontally at a frequency of two rotations per second; a positive test is the exacerbation of an existing headache. The jolt accentuation test has a sensitivity of 97% and specificity of 60% for the presence of CSF pleocytosis.11 Therefore, a negative test essentially can exclude meningitis in patients with fever and headache, and a positive result aids in the decision to proceed with lumbar puncture (LP).7,11"



Note: If negative still beware of encepahlitis, which may not have meningeal signs but classically presents with some combination of: neurologic symptoms, headache, fever, muscle/joint aches, AMS.