Meningeal Irritation

Aka: Meningeal Irritation, Brudzinski's Sign, Kernig's Sign, Spinal Rigidity, Nuchal Rigidity

1. See Also
   1. Oostenbrink Clinical Decision Rule for Meningitis
2. Causes
   1. Meningitis
   2. Meningismus
   3. Subarachnoid Hemorrhage
   4. Posterior fossa tumor
   5. Increased Intracranial Pressure
3. Efficacy: Meningeal signs
   1. Do not rely on these signs due to low efficacy
   2. Kernig's Sign and Brudzinski's Sign
      1. Test Sensitivity: 5%
      2. Test Specificity: 95%
   3. Nuchal Rigidity
      1. Test Sensitivity: 30%
      2. Test Specificity: 68%
   4. References
      1. Thomas (2002) Clin Infect Dis 35:46-52
4. Exam: Nuchal Rigidity
   1. Involuntary muscle spasm limits passive neck flexion
   2. Patient cannot flex neck to place chin on chest
   3. Unreliable in age under 18 months due to underdeveloped neck musculature
5. Exam: Spinal Rigidity
   1. Erector spinae muscle spasm limits spine movement
   2. Opisthotonos (rigid arched back) may occur
6. Exam: Kernig's Signs
   1. Technique
      1. Patient supine
      2. Flex both hip and knee to 90 degrees
      3. Hold hip immobile and extend knee
   2. Positive Test suggesting Meningeal Irritation
      1. Resistance to knee extension
      2. Pain in hamstrings
7. Exam: Brudzinski's Sign
   1. Technique
      1. Patient supine
      2. Immobilize trunk against bed
      3. Flex neck, chin to chest
   2. Positive Test suggesting Meningeal Irritation
      1. Involuntary hip flexion