Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Jeseph gedshaw MD
Raddek stuart MD
The terms meningeal signs and meningismus refer to the physical findings that develop after
meningeal irritation from inflammation, tumor, or hemorrhage. Those most widely known are
neck stiffness (or nuchal rigidity), Kernig sign, and Brudzinski sign.
A. NECK STIFFNESS1,2
Neck stiffness denotes involuntary resistance to neck flexion, which the clinician perceives
when trying to bend the patients neck, bringing the chin down to the chest. Occasionally,
the aggravated extensor tone of the neck and spine is so severe that the patients entire
spine is hyperextended, leaving the torso of the supine patient supported only by the
occiput and the heels, an extreme posture called opisthotonus.
B. KERNIG SIGN3,6,8
The Kernig sign was first described by Vladimir Kernig in 1882. With the patients hip and
knee flexed, the Kernig sign is positive when the patient resists extension of the knee. Kernig
called this a contracture of the hamstrings because the knee would not extend beyond 135
degrees (with the hip flexed), even though the knee extended fully if the hip was first
positioned in the fully extended position. Most clinicians perform this test in the supine
patient, although Kernig described the test being performed in the seated patient.
C. BRUDZINSKI SIGNs4,5,,6,7,8
Jozef Brudzinski described several meningeal signs between 1909 and 1916.
Brudzinskis
contralateral leg sign
Brudzinskis reciprocal
contralateral leg sign
Brudzinskis cheek sign
Brudzinskis symphysis
sign
Brudzinskis Neck Sign
Guillands sign
Edelmann great
toe phenomenon
Flexion of contralateral
hip and knee
Sensitivity
(%)
Specificity
(%)
Detecting Meningitis
Neck Stiffness
Kernig's Sign
Brudzinski's Neck Sign
Detecting Intracranial
Hemorrhage
Neck Stiffness
Kernig's Sign or
Brudzinski's Neck Sign
Absent
41-52
9-18
9-14
69-71
93-96
94-96
1.5
2.4
NS
NS
NS
NS
16-48
3-15
81-98
98
5.4
NS
0.7
NS
* Diagnostic standard: for meningitis, cerebrospinal fluid pleocytosis 100 WBC / microliter.
for intracranial hemorrhage: Neuroimaging