Meningeal Irritation

Signs of meningeal irritation

Bacterial meningitis is present in approximately 30% of children with signs of meningeal irritation. (Oostenbrink et al, 2001)

Brudzinski's Sign

Technique

  • Patient supine

  • Immobilize trunk against bed

  • Flex neck, chin to chest

Positive Test suggesting Meningeal Irritation

  • Involuntary hip flexion

 

Sensitivity: 9-14%

Specificity: 94-96%

(McGee, 2013)

 

Video courtesy MDforAll channel, YouTube

Kernig's Sign

Technique

  • Patient supine

  • Flex both hip and knee to 90 degrees

  • Hold hip immobile and extend knee

Positive Test suggesting Meningeal Irritation

  • Resistance to knee extension

  • Pain in hamstrings

 

Sensitivity: 9-18% 

Specificity: 93-96%

(McGee, 2013)

 

Video courtesy MDforAll channel, YouTube

Nuchal Rigidity
  • Involuntary muscle spasm limits passive neck flexion

  • Patient cannot flex neck to place chin on chest

  • Unreliable in age under 18 months due to underdeveloped neck musculature

 

Sensitivity: 41-52%

Specificity: 69-71%

(McGee, 2013)