Meningitis is a common life-threatening medical emergency caused by infectious and non-infectious agents. Rapid and accurate evaluation by history and clinical examination is helpful to guide further specific investigation and treatment. Kernig's sign, Brudzinski's sign, and nuchal rigidity are bedside diagnostic signs used to evaluate suspected cases of meningitis. The presence of meningeal irritation, however, is not pathognomonic for meningitis. Vladimir Mikhailovich Kernig , a Russian physician, described first meningeal sign, known as Kernig's sign.
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NCBI Bookshelf. Kernig sign is one of the eponymous clinical signs of meningitis. This resistance is thought to be due to meningeal inflammation in the setting of meningitis or other clinical entities that may irritate the meninges. Since its conception in the 19th century, the clinical value of Kernig sign has been more thoroughly explored.
It remains a commonly performed maneuver in cases of suspected meningitis. Kernig sign was initially described in the 19th century by Russian physician Vladimir Kernig. Kernig observed that patients who had bacterial or tuberculous meningitis were unable to completely extend their legs while sitting upright. He continued to investigate this finding over several decades of his career and first reported this sign at a medical congress in St.
Petersburg in He presented his observations again in Copenhagen, Denmark in and published the same year in Berliner Klinische Wochenschrift. Kernig described a positive sign as the inability to extend the knees more than degrees. In severe cases, patients were unable to extend the knees past 90 degrees. The maneuver was performed with the patient seated in the upright position with the hips flexed 90 degrees to the trunk.
Kernig also described instances in which patients were unable to extend the elbows in cases of meningitis. Kernig did not use pain as a marker for a positive test.
The presence of contracture or extensor spasm at the knee was considered a positive finding. He noted, however, that the clinical severity of meningitis was not always associated with the severity of contraction of the extremities. In clinical practice, it is important to have the infant relaxed at the time of the test. Babies who are extremely irritable or tense do not make good candidates for the test. To elicit Kernig sign, clinicians typically perform the exam with the patient lying supine with the thighs flexed on the abdomen and the knees flexed.
The examiner then passively extends the legs. In the presence of meningeal inflammation, the patient will resist leg extension or describe pain in the lower back or posterior thighs, which indicates a positive sign.
The Brudzinski nape of the neck sign was described in by Polish pediatrician Brudzinski. A positive Brudzinski sign refers to the maneuver in which the clinician passively flexes the neck, which then results in flexion of the hips and the knees of the patient.
If meningitis is suspected, it is mandatory that the infant undergoes a lumbar puncture. The differential diagnosis in the setting of positive signs includes spinal cord tumors, myelitis, intervertebral disc prolapse, sciatica, multiple sclerosis, trauma, subarachnoid hemorrhage, and increased intracranial pressure from multiple causes or in the setting of stroke. When seen in meningitis, these signs are usually present acutely within 24 hours of symptom onset. It is thought that these findings are due to mechanical factors in the spine.
When the meninges in the spinal cord and spinal nerves are inflamed, patients will resist stretching the cord and the nerves to prevent pain resulting from this inflammation.
These clinical maneuvers are thought to provoke this stretching. This is why contractures occur when performed, resulting in a positive test. Bacterial meningitis is an important cause of morbidity and mortality across the world. Physical exam findings, including nuchal rigidity, Kernig, and Brudzinski signs are used at the bedside to help in the diagnosis of cases of suspected meningitis.
Several studies have evaluated the utility and accuracy of these bedside exam findings for diagnosing meningitis. The jolt accentuation maneuver, described more recently in , is a bedside maneuver to identify cases of meningitis with exacerbation of a headache caused by rotation of the head horizontally two or three times per second.
Meningitis is an important disease entity that carries high rates of morbidity and mortality, requiring early recognition and management. Kernig sign is a bedside physical exam maneuver used since its description in the 19th century to help in the diagnosis of meningitis. Due to its low sensitivity, the absence of Kernig sign does not rule out meningitis; however, with its high specificity, a positive Kernig sign is highly suggestive of the diagnosis.
It is important for the healthcare worker to be aware that the gold standard test for meningitis is the lumbar puncture to assess the cerebrospinal fluid. No physical sign can replace this test. However, if the test is positive, then the test is highly specific for meningitis. Of course, a positive test must be correlated with clinical and laboratory features.
To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Affiliations 1 Temple University Hospital. Introduction Kernig sign is one of the eponymous clinical signs of meningitis. Preparation In clinical practice, it is important to have the infant relaxed at the time of the test.
Technique To elicit Kernig sign, clinicians typically perform the exam with the patient lying supine with the thighs flexed on the abdomen and the knees flexed. Questions To access free multiple choice questions on this topic, click here.
References 1. Am Fam Physician. Forgie SE. Jolt accentuation of headache and other clinical signs: poor predictors of meningitis in adults. Am J Emerg Med. Absence of jolt accentuation of headache cannot accurately rule out meningitis in adults.
Clinical features suggestive of meningitis in children: a systematic review of prospective data. The rational clinical examination. Does this adult patient have acute meningitis? Nevropatol Psikhiatriia. Kernig Sign. In: StatPearls [Internet]. In this Page. Related information. Similar articles in PubMed.
Pediatr Infect Dis J. Review Chapter a history of bacterial meningitis. Tyler KL. Handb Clin Neurol. Emerg Tehran. Epub Jan Epub Oct Josef Brudzinski and Vladimir Mikhailovich Kernig: signs for diagnosing meningitis. Clin Med Res. Recent Activity. Clear Turn Off Turn On.
Meningitis is a life-threatening medical emergency characterized by the inflammation of the membranes surrounding your spinal cord and brain. Prompt diagnosis and treatment of meningitis is important to prevent further complications. There are additional signs and symptoms to look out for if you suspect you have meningitis. Early symptoms will be similar to the flu, and they can develop over a matter of hours or even days. Symptoms include:. The Brudzinski sign is another way to diagnose meningitis. The Brudzinski sign was created by Josef Brudzinski, a Polish pediatrician.
Appraisal of Kernig's and Brudzinski's sign in meningitis
How to Recognize Kernig’s Sign
Meningism is a set of symptoms similar to those of meningitis but not caused by meningitis. It therefore requires differentiating from other CNS problems with similar symptoms, including meningitis and some types of intracranial hemorrhage. Related clinical signs include Kernig's sign and three signs all named Brudzinski's sign. In this sense, the word implies "suspected meningitis". The words "meningeal symptoms" can be used instead to avoid confusion between the word senses , thus reserving the term "meningism" for its strict sense. Readers of the medical literature should remain aware that the words are used in more than one sense. The main clinical signs that indicate meningism are nuchal rigidity , Kernig's sign and Brudzinski's signs.