Exam

Meningeal Irritation

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

  • Causes
  1. Intracranial causes
    1. Intracranial Mass (esp. Posterior fossa tumor)
    2. Subarachnoid Hemorrhage
    3. Meningitis
    4. Meningismus
    5. Increased Intracranial Pressure
  2. Extracranial Causes
    1. Retropharyngeal or cervical Lymphadenitis (especially young children)
    2. Retropharyngeal Abscess or Cellulitis
    3. Sinusitis
    4. Mastoiditis
    5. Torticollis
    6. Dystonic Reaction
    7. Cervical SpineOsteomyelitis
    8. Upper lobe Pneumonia
  • 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 [PubMed]
  • 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
  • Exam
  • Spinal Rigidity
  1. Erector spinae muscle spasm limits spine movement
  2. Opisthotonos (rigid arched back) may occur
  • 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
  • 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