The main clinical signs that indicate meningism are nuchal rigidity, Kernig's sign and Brudzinski's signs. None of the signs are particularly sensitive; in adults with meningitis, nuchal rigidity was present in 30% and Kernig's or Brudzinski's sign only in 5%.
Nuchal rigidity Nuchal rigidity is the inability to flex the
neck forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent.
Kernig's sign Kernig's sign (after
Waldemar Kernig (1840–1917), a
Russian neurologist) is positive when the thigh is flexed at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance). This may indicate subarachnoid hemorrhage or meningitis. Patients may also show
opisthotonus—spasm of the whole body that leads to legs and head being bent back and body bowed forward.
Brudzinski's signs Jozef Brudzinski (1874–1917), a
Polish pediatrician, is credited with several signs in meningitis. The most commonly used sign (
Brudzinski's neck sign) is positive when the forced
flexion of the neck elicits a reflex flexion of the hips, with the patient lying
supine. Other signs attributed to Brudzinski: • The symphyseal sign, in which pressure on the
pubic symphysis leads to abduction of the leg and reflexive hip and knee flexion. • The cheek sign, in which pressure on the cheek below the
zygoma leads to rising and flexion in the forearm. ==See also==