Author information Article notes Copyright and License information Disclaimer. Department of Neurology, G. Pant Hospital, New Delhi, India. For correspondence: Dr. Man mohan Mehndiratta, Academic block, G.
Pant Hospital, J. Marg, New Delhi, India. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Introduction Meningitis is a common life-threatening medical emergency caused by infectious and non-infectious agents. Historical origin and clinical aspects Kernig's sign Vladimir Mikhailovich Kernig , a Russian physician, described first meningeal sign, known as Kernig's sign.
Open in a separate window. Figure 1. Brudzinski's sign Josef Brudzinski , a Polish born pediatrician in early nineties, described 4 maneuvers for the clinical diagnosis of meningitis: The obscure cheek sign, symphyseal sign, Brudzinski's reflex, and the most popular Brudzinski neck sign.
References 1. Kernig VM. Ueber ein kankheits symptom der acuten meningitis. The jolt accentuation maneuver, described more recently in , is a bedside maneuver to identify cases of meningitis with exacerbation of a headache caused by rotation of the head horizontally two or three times per second.
The diagnosis and management of meningitis are to be done with an interprofessional team that includes an emergency department physician, infectious disease specialist, neurologist, nurse practitioner, and pediatrician. Meningitis is an important disease entity that carries high rates of morbidity and mortality, requiring early recognition and management. Kernig sign is a bedside physical exam maneuver used since its description in the 19th century to help in the diagnosis of meningitis.
Due to its low sensitivity, the absence of the Kernig sign does not rule out meningitis; however, with its high specificity, a positive Kernig sign is highly suggestive of the diagnosis. Much of the literature on Kernig sign is many years old, and there are no randomized studies to determine its validity. The healthcare worker needs to be aware that the gold standard test for meningitis is the lumbar puncture to assess the cerebrospinal fluid.
No physical sign can replace this test. The Kernig test is not very sensitive to meningitis, and if absent, it does not mean that the patient does not have meningitis. However, if the test is positive, then the test is highly specific for meningitis. Of course, a positive test must correlate with clinical and laboratory features. American family physician.
The Pediatric infectious disease journal. The American journal of emergency medicine. Does this adult patient have acute meningitis? Therapeutic advances in neurological disorders. Annals of Indian Academy of Neurology. Nevropatologiia i psikhiatriia. BMC research notes. Kernig Sign. Google Scholar Crossref. Search ADS. Community-acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing.
Computed tomography of the head before lumbar puncture in adults with suspected meningitis. Acute meningitis with a negative Gram's stain: clinical and management outcomes in episodes.
Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. Practice parameters: lumbar puncture summary statement. Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. Spectrum bias in the evaluation of diagnostic tests: lessons from the rapid dipstick test for urinary tract infection. Issue Section:. Download all slides. Comments 0. Add comment Close comment form modal.
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