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Meningitis: from Kernig and Brudzinski to the 21st century
  1. J Gareth Llewelyn
  1. Correspondence to Dr J Gareth Llewelyn, Department of Neurology, University Hospital of Wales, Cardiff, UK; jgllewelyn{at}

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Over 200 years after Thomas Willis described the clinical features of ‘inflammation of the meninges with continual fever’, Heinrich Quincke used his new lumbar puncture technique to analyse the cerebrospinal fluid (CSF). At the same time, in the late 19th century, Waldemar Kernig and Jozef Brudzinski added further clinical features of meningitis to the bedside diagnosis. Effective treatments started with equine antiserum for meningococcal meningitis early in the 20th century, followed by the discovery of sulphonamides, but then the prognosis dramatically improved when high-dose penicillin became available after World War II.

Even today, an acute admission with suspected meningitis is a clinical challenge, and so the British Infection Association's updated guidelines on the diagnosis and management of acute meningitis1 are welcome. The poster summarising the guidelines (see figure 1) should be in all acute admissions settings and general practitioner surgeries. Neurologists should work with acute physicians to promote the audit tool (see that accompanies these …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Andrew Chancellor, Tauranga, New Zealand.