Brudzinski’s Sign: Difference between revisions

m (Corrected test instructions)
No edit summary
 
(4 intermediate revisions by 2 users not shown)
Line 7: Line 7:
== Description  ==
== Description  ==


Brudzinski's sign is one of the physically demonstrable symptoms of meningitis. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.<ref>http://www.nlm.nih.gov/medlineplus/ency/imagepages/19069.htm</ref>  
'''Brudzinski's sign''' is one of the physically demonstrable symptoms of meningitis. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.<ref>http://www.nlm.nih.gov/medlineplus/ency/imagepages/19069.htm</ref><ref>Manmohan Mehndiratta, Rajeev Nayak, Hitesh Garg, Munish Kumar, and Sanjay Pandey (2012). Appraisal of Kernig's and Brudzinski's sign in meningitis.Ann Indian Acad Neurol. 2012 Oct-Dec; 15(4): 287–288.
doi:  10.4103/0972-2327.104337</ref>  


== Purpose  ==
== Purpose  ==


Indicates meningeal irritation.<ref>Introduction to Emergency Medicine edited by Elizabeth Mitchell, Ron Medzon. Lippincott Williams &amp; Wilkins, 2005</ref> <br>  
'''Brudzinski's sign''' is used to diagnose [https://physio-pedia.com/Meningitis?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal#share '''meningitis''']<br>


<u>Technique</u>
== Technique ==
To perform the '''Brudzinski's sign'''


In a quiet environment with the client resting in a supine position:
'''Step 1.'''  Patient in supine position  


• Gently grasp the patient's head from behind and place the other hand on the patient's chest<br>• Gently flex the neck, bringing chin to chest<br>• Positive sign is involuntary flexing of hips and knees (an involuntary reaction to lessen the stretch on the inflamed meninges)<br><br>
'''Step 2.'''  Gently grasp the patient's head from behind and place the other hand on the patient's chest  


'''Step 3.'''  Gently flex the neck, bringing chin to chest
'''Step 4.'''  Positive sign is involuntary flexing of hips and knees (an involuntary reaction to lessen the stretch on the inflamed meninges)<br><br>
{{#ev:youtube|uJDxuYylH3c}}
{{#ev:youtube|uJDxuYylH3c}}


== Evidence<ref>Karen E. Thomas, Rodrigo Hasbun, James Jekel, Vincent J. Quagliarello. The Diagnostic Accuracy of Kernig's Sign, Brudzinski's Sign, and Nuchal Rigidity in Adults with Suspected Meningitis. Clin Infect Dis. (2002) 35 (1): 46-52.</ref>  ==
== Evidence ==
The study was done on 297 adults with suspected meningitis to determine the diagnostic accuracy of '''[https://physio-pedia.com/Kernig's_Sign?utm_source=physiopedia&utm_medium=related_articles&utm_campaign=ongoing_internal#share Kernig's sign], Brudzinski's sign,''' and '''Nuchal rigidity''' for meningitis And the study shows kernig's sign has diagnostic value of


Sensitivity: 5; Specificity: 95; Positive likelihood ratio: 0.97; Negative likelihood ratio: 1.0
[https://physio-pedia.com/Test_Diagnostics#share '''Sensitivity'''] '''5%'''<ref name=":0">Karen E. Thomas, Rodrigo Hasbun, James Jekel, Vincent J. Quagliarello, The Diagnostic Accuracy of Kernig's Sign, Brudzinski's Sign, and Nuchal Rigidity in Adults with Suspected Meningitis, ''Clinical Infectious Diseases'', Volume 35, Issue 1, 1 July 2002, Pages 46–52, <nowiki>https://doi.org/10.1086/340979</nowiki></ref>


See [http://www.physio-pedia.com/Test_Diagnostics test diagnostics page] for an explanation of statistics.
[https://physio-pedia.com/Test_Diagnostics#share '''Specificity'''] '''95%'''<ref name=":0" />


<br>  
[https://physio-pedia.com/Test_Diagnostics#share '''Positive predictive value'''] '''27%'''<ref name=":0" />


== References ==
[https://physio-pedia.com/Test_Diagnostics#share '''Negative predictive value'''] '''72%'''<ref name=":0" />
 
The results of this study shows that the diagnostic accuracy of Kernig's sign and Brudzinski's sign was poor for patients with moderate and severe meningeal inflammation and patients with microbiological evidence of CSF infection. And also patients with severe meningitis on the basis of laboratory evidence both Kernig's sign and Brudzinski's sign as low diagnostic value.[3]
 
Another study suggest that Kernig's sign and Brudzinski's sign as low sensitivity and high specificity for diagnosing meningitis.<ref name=":1">Mehndiratta M, Nayak R, Garg H, Kumar M, Pandey S. Appraisal of Kernig's and Brudzinski's sign in meningitis. ''Ann Indian Acad Neurol''. 2012;15(4):287-288. doi:10.4103/0972-2327.104337</ref>
* low sensitivity suggest when both sign absent should not conclude that there is no evidence of meningitis<ref name=":1" />
* high specificity suggest when both sign is present there is a high likelihood for meningitis.<ref name=":1" />
* In clinical practice both kernig's and brudzinski's sign are frequently performed together.<ref name=":1" />
 
== References ==
#David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.


<references />  
<references />  
<ref>Manmohan Mehndiratta, Rajeev Nayak, Hitesh Garg, Munish Kumar, and Sanjay Pandey (2012). Appraisal of Kernig's and Brudzinski's sign in meningitis.Ann Indian Acad Neurol. 2012 Oct-Dec; 15(4): 287–288.
doi:  10.4103/0972-2327.104337</ref>


[[Category:Special_Tests]]
[[Category:Special_Tests]]
<references />

Latest revision as of 20:54, 3 September 2020

Original Editor ­ Oyemi Sillo

Top Contributors - Sweta Christian, Oyemi Sillo, Kim Jackson, Anas Mohamed, 127.0.0.1, Admin, Evan Thomas and WikiSysop ­

Description[edit | edit source]

Brudzinski's sign is one of the physically demonstrable symptoms of meningitis. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.[1][2]

Purpose[edit | edit source]

Brudzinski's sign is used to diagnose meningitis

Technique[edit | edit source]

To perform the Brudzinski's sign

Step 1. Patient in supine position

Step 2. Gently grasp the patient's head from behind and place the other hand on the patient's chest

Step 3. Gently flex the neck, bringing chin to chest

Step 4. Positive sign is involuntary flexing of hips and knees (an involuntary reaction to lessen the stretch on the inflamed meninges)

Evidence[edit | edit source]

The study was done on 297 adults with suspected meningitis to determine the diagnostic accuracy of Kernig's sign, Brudzinski's sign, and Nuchal rigidity for meningitis And the study shows kernig's sign has diagnostic value of

Sensitivity 5%[3]

Specificity 95%[3]

Positive predictive value 27%[3]

Negative predictive value 72%[3]

The results of this study shows that the diagnostic accuracy of Kernig's sign and Brudzinski's sign was poor for patients with moderate and severe meningeal inflammation and patients with microbiological evidence of CSF infection. And also patients with severe meningitis on the basis of laboratory evidence both Kernig's sign and Brudzinski's sign as low diagnostic value.[3]

Another study suggest that Kernig's sign and Brudzinski's sign as low sensitivity and high specificity for diagnosing meningitis.[4]

  • low sensitivity suggest when both sign absent should not conclude that there is no evidence of meningitis[4]
  • high specificity suggest when both sign is present there is a high likelihood for meningitis.[4]
  • In clinical practice both kernig's and brudzinski's sign are frequently performed together.[4]

References[edit | edit source]

  1. David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
  1. ↑ http://www.nlm.nih.gov/medlineplus/ency/imagepages/19069.htm
  2. ↑ Manmohan Mehndiratta, Rajeev Nayak, Hitesh Garg, Munish Kumar, and Sanjay Pandey (2012). Appraisal of Kernig's and Brudzinski's sign in meningitis.Ann Indian Acad Neurol. 2012 Oct-Dec; 15(4): 287–288. doi: 10.4103/0972-2327.104337
  3. ↑ 3.0 3.1 3.2 3.3 Karen E. Thomas, Rodrigo Hasbun, James Jekel, Vincent J. Quagliarello, The Diagnostic Accuracy of Kernig's Sign, Brudzinski's Sign, and Nuchal Rigidity in Adults with Suspected Meningitis, Clinical Infectious Diseases, Volume 35, Issue 1, 1 July 2002, Pages 46–52, https://doi.org/10.1086/340979
  4. ↑ 4.0 4.1 4.2 4.3 Mehndiratta M, Nayak R, Garg H, Kumar M, Pandey S. Appraisal of Kernig's and Brudzinski's sign in meningitis. Ann Indian Acad Neurol. 2012;15(4):287-288. doi:10.4103/0972-2327.104337
Retrieved from "https://www.physio-pedia.com/index.php?title=Brudzinski’s_Sign&oldid=246903"