Brudzinski’s Sign

Original Editor ­ Oyemi Sillo

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

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.[1][2]

Purpose

Brudzinski's sign is used to diagnose meningitis

Technique

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

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

  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