Brudzinski meningeal symptoms. What are Kernig’s and Brudzinski’s symptoms Neck stiffness Kernig’s symptom

Brudzinski's sign is a group special symptoms related to meningeal, which arise as a result of irritation meninges. include drowsiness, severe headache, vomiting and stupor. Brudzinski's sign itself is a flexion of the knees and hips in response to the patient's passive flexion of the neck. This is one of the most important early signs diseases such as meningitis. It should be especially noted that this symptom may occur in both adults and children, although for patients younger age it is more typical in the case of meningeal disorders. At the same time, checking for the presence of Brudzinski’s sign does not apply to routine medical examinations.

The main reasons for the development of symptoms

As for the main reasons that can provoke its appearance, then, first of all, it is necessary to isolate such an infection as In this case, the symptom will be observed in a person only twenty-four hours after the onset of this disease. In addition, Brudzinski's symptom can be recorded when acute form arthritis of the spine. Also this sign can be detected two to three minutes after the onset of subarachnoid bleeding. In this case, both in the latter case and in the case of meningitis, meningeal disorders are observed due to the accumulation of exudate or blood pressure around the nerve endings located in the spinal cord.

Brudzinski's five symptoms

Currently, experts identify five main symptoms of Brudzinski. Firstly, this is a zygomatic sign, determined by bending the knees in response to tapping on the so-called zygomatic arch. The average Brudzinski symptom, or, in other words, the pubic symptom, is fixed by pressing on the patient. In this case, the doctor also bends the patient’s legs at the knee and hip joints. Pressing on the cheek below the zygomatic arch and raising the shoulders is a buccal Brudzinski sign. The upper (occipital) sign is determined when the patient's legs are flexed at the knee and hip joints simultaneously with passive flexion of the head. It should also be said about the fifth (lower) symptom. It is fixed at the moment when the patient, who is lying on his back, bends his leg at the hip joint and extends it at the knee.

List of clinical indications

The manifestation of any of the listed Brudzinski symptoms should be reported to the doctor immediately. This is due to the fact that a person with these types of symptoms is usually seriously ill and requires constant monitoring vital signs And intracranial pressure. In addition, neurological examinations and cardiovascular testing are necessary. Brudzinski's symptom also requires such diagnostic procedures as cultures of blood, urine, sputum and

Kernig's symptom is one of the primary signs confirming the presence of irritation of the lining of the brain. The condition is observed in meningitis, stroke and other pathologies of brain tissue. The symptom is named after the Russian doctor Vladimir Mikhailovich Kernig. He studied reflexes in case of brain damage, discovered and described this phenomenon.

Kernig's sign

Diagnostics

The syndrome is diagnosed as follows:

• the patient lies on his back, the doctor bends his leg in hip joint and at the knee, the flexion angle is ninety degrees;
• at the next stage the doctor tries to straighten the leg in knee joint.

If the patient has meningeal syndrome, then lower limb will not fully accelerate. This is due to the fact that the tone of the muscles responsible for flexing the legs is increased.

Reasons why Kernig's sign may appear

In medicine, there are the following disorders that cause this condition:
• meningitis - Kernig syndrome diagnoses this disease in the first stages of the disease;
• herniated discs, cancer spinal cord;
• subarachnoid hemorrhage - it can be detected soon after its appearance. IN in this case Kernig syndrome will show a positive result;
• tumor on the spinal cord - main feature of this disease, pain localized in the direction spinal nerve, meningeal syndrome will be a minor symptom.

Manifestations of Kernig's sign

1. Positive result– in this case, the legs are not able to fully straighten at the knees. This occurs due to spasm in the lower leg muscles. The result suggests that the membranes of the brain are irritated and intracranial pressure is increased.
2. Negative result - manifests itself when the patient has hemiparesis (increase or decrease muscle tone, which is one-sided), with neurological diseases(Alzheimer's or Parkinson's disease).

What diseases lead to positive Kernig's syndrome?

Liver diseases

For pathologies of this body fixed positive reaction Kernig's sign. The fact is that with liver diseases, the amount of bilirubin increases and jaundice appears. These factors lead to meningeal changes, since toxic substances act on brain tissue. The following symptoms are observed in liver diseases:

• forced posture of the patient - arched torso and retracted abdomen;
• the neck muscles become rigid,
• severe headaches caused by increased intracranial pressure;
• the back muscles of the thigh are very tense.

Bacterial infections

A number of diseases that are caused by bacteria lead to meningitis. These include salmonellosis or diphtheria. With these diseases, the patient exhibits a positive Kernig sign, but it is accompanied by other symptoms:

• The patient has a stiff neck;
• the patient is forced to assume the “coping dog” pose - he sucks in his stomach, arches his back, and presses his arms to his chest.

General cerebral disorders

Any damage to the brain tissue (due to inflammation, cancer, trauma) appears clinical symptoms. They are usually accompanied by Kernig's sign. General cerebral disorders are characterized by the following symptoms:

• strong headache,
• convulsions,
• dizziness,
• impaired functioning of consciousness,
• nausea,
• gagging.

These symptoms occur because metabolic, toxic, and vascular changes occur in the brain tissue. They also lead to disorientation in space, hallucinations, and deafness. The extreme degree of cerebral disorders is expressed by coma. In this case, all meningeal syndromes are very pronounced.

Brudzinski syndrome

It represents a group of symptoms that are classified as meningeal. Brudzinski syndrome helps identify whether there is damage to the meninges. This is achieved by provoking the meningeal position.

There are five symptom options:

• Brudzinski's pubic syndrome - the doctor presses on the pubic area; if there is inflammation of the lining of the brain, the patient will bend his knees;
• lower symptom - the doctor bends the patient’s leg at the knee, at this time the second leg bends involuntarily.

These symptoms were developed by the Polish doctor Joseph Brudzinski. Together with Kernig's symptom, they are used in neurological practice to find out whether the patient's lining of the brain is inflamed.

This syndrome allows you to determine whether a person has meningitis infant. It lies in the fact that infant take under the arms and lift. IN this state he pulls his legs towards his stomach and holds them in this state, throwing his head back a little. Healthy child in this position you will be able to bend and straighten your legs freely.

Meningitis

Causes of meningitis

This disease is infectious nature. It causes inflammation of the membranes of the brain and spinal cord. Meningitis ranks tenth among all common infections.

Meningitis can occur for the following reasons:

• • taking some types medicines: corticosteroids, immunosuppressants, some types of antibiotics;
  • furunculosis of the face or neck,
  • the presence of brain tumors or cysts,

Inflammation of the meninges is characterized not only by the Kernig, Brudzinsky and Lesage symptom. There are a number of other signs of the disease. The illness begins suddenly and is initially similar to the flu. Manifested by the following symptoms:

• severe weakness
• temperature rise to 39 degrees,
• painful sensations throughout the body,
• loss of appetite.

Within a few hours or days, the following symptoms will begin to appear:

• vomit,
• convulsions,
• strong, unbearable pain, which intensifies when turning the head or any noise,
• rashes on the skin,
• strabismus,
• confusion (with severe forms meningitis).

In this article we tell you how intercostal neuralgia on the left manifests itself.
What symptoms indicate the presence intercostal neuralgia on the right, read here

At-risk groups

Meningeal syndromes occur in the following groups:

• • In people who long time received treatment with chemotherapy drugs, cytostatics, and some types of antibiotics;
  • In patients who have had or are suffering from bacterial infections. For example: toxpolazmosis or echinococcosis, etc.;
  • Young children, young and elderly people are predisposed to the disease;
  • A risk factor is missing vaccination - if a child under 2 years of age has not been vaccinated against mumps, then the likelihood of meningeal syndromes increases;

• People suffering from liver diseases, infections caused by bacteria;
• Patients who have general cerebral disorders (they can be observed with brain injuries, cancer of brain tissue and other inflammations);
• Visiting places (African countries) where there is a high percentage of meningitis - when traveling to such countries it is worth getting the necessary vaccinations.

What are Kernig and Brudzinski's signs?

If the lining of the brain and spinal cord is damaged as a result of meningeal infection or hemorrhage, the most important symptoms to establish the primary diagnosis are manifestations established through the works of Polish and Russian pediatricians - Joseph Brudzinsky and Vladimir Kernig.

Therapist-developed methods primary diagnosis lesions of the meninges allow short term provide the necessary therapeutic treatment, preventing dire consequences diseases. Let's take a closer look at the signs of brain injury in this article.

Characteristics of the syndrome

The Brudzinsky and Kernig determination method consists of identifying early signs of irritation of the meninges by infectious agents or traumatic injuries.

Kernig and Brudzinski syndrome is of particular value, as it allows one to determine the presence of the disease in the early stages, ahead of instrumental and laboratory diagnostics.

The causes of the positive syndrome are diseases such as:

• sepsis;
• meningitis;
• cancer and metastasis;
• benign tumors of the spinal cord and brain (approx. hemangioma);
• cerebral hemorrhage, stroke;
• purulent inflammatory diseases ENT organs (otitis, sinusitis);
• abscess;
• open wounds in the spinal column.

Scientists long years studied the effect of central nervous system damage on the primary reflexes of patients. As a result of research, they found a relationship between muscle resistance in the neck, lower and upper extremities and brain damage.

Kernig syndrome

Developed in the 20th century, the Kernig symptom has not lost its relevance to this day and is help in diagnosing serious pathologies of the central nervous system.

To check for a positive Kernig sign, the patient is placed on his back and one leg is bent at a right angle at the pelvic and knee joints.

This symptom appears on both sides of the patient’s body.

An exception to the rule is those cases when the patient, in addition to damage to the meninges, has paresis - muscle weakening, then the Kernig symptom may not be negative on both or one side of the body.

In old age, flexor muscles are prone to increased tone and contracture. In this case, a false-positive syndrome may be noted.

Brudzinski syndrome

Brudzinsky studied the reflexes of other articular joints with damage to the meninges. To confirm the syndrome, it is necessary to check involuntary flexion of the knee joints with the patient lying on his back.

There are upper, middle, lower Brudzinski syndrome.

Upper the symptom characterizes an increase in the tone of the neck muscles. When a physician attempts to passively move the patient's chin toward chest, there is a tightening of the knee joints with simultaneous resistance in the neck.

Average or a positive pubic symptom is detected if, when pressing on the pubic bone, an involuntary flexion movement in the legs occurs.

Lower the symptom was developed jointly with Kernig and exactly repeats the previously described phenomenon: when the patient’s leg is passively flexed, it is not possible to straighten it at the knee.

In addition, Brudzinsky noticed that when pressing on the lower point of the zygomatic arch, a person involuntarily contracts the trapezius muscle, pulling the shoulders towards the ears, and also bends upper limbs at the elbows.

What to do if there is a positive reaction

Positive Brudzinski and Kernig syndrome suggests the presence of pathologies of the meninges. However, the primary diagnosis must be confirmed by general clinical picture, Ultrasound, MRI, CT, blood tests, lumbar and physical examination.

Based on the diagnostic results, type and degree of the disease, the doctor selects an effective treatment.

Meningeal infection requires taking antibiotics, reducing the reabsorption of water and salts in tissues and their accelerated excretion from the body, as well as restoring the balance of electrolytes.

In case of tumor neoplasms, the patient should surgical intervention and radiation therapy.

For cerebral hemorrhage the patient is prescribed medications that prevent the formation of blood clots and increased blood clotting, prevent damage to neural networks, and inhibit the oxidation of free radicals and other toxic substances.

IN severe stages the disease is subject to surgical intervention.

Conclusion

Kernig's and Brudzinski's symptoms make it possible to identify pathology of the spinal cord and brain at an early stage.

Thanks to timely treatment of infectious lesions, therapy in most cases ends with a complete recovery of the patient.

When identifying malignant tumors and thrombosis, early treatment does not diminish the consequences of the disease, but can prevent some symptomatic manifestations.

To prevent damage to the lining of the brain, experts recommend vaccination against infectious pathogens, timely treatment of ARVI, influenza, bacterial diseases, exercise regularly, keep an eye on blood pressure and stick to healthy image life.

Source: https://revmatolog.org/drugie-zabolevaniya/simptomy-kerniga-i-brudzinskogo.html

Kernig's, Brudzinski's, Lesage's symptoms: how they manifest themselves and what they indicate

Kernig's symptom is one of the primary signs confirming the presence of irritation of the lining of the brain. The condition is observed in meningitis, stroke and other pathologies of brain tissue. The symptom is named after the Russian doctor Vladimir Mikhailovich Kernig. He studied reflexes in case of brain damage, discovered and described this phenomenon.

Diagnostics

The syndrome is diagnosed as follows:

• the patient lies on his back, the doctor bends his leg at the hip joint and knee, the flexion angle is ninety degrees;
• at the next stage, the doctor tries to straighten the leg at the knee joint.

If the patient has meningeal syndrome, the lower limb will not fully straighten. This is due to the fact that the tone of the muscles responsible for flexing the legs is increased.

Reasons why Kernig's sign may appear

In medicine, there are the following disorders that cause this condition:
• meningitis– Kernig syndrome diagnoses this disease in the early stages of the disease;
• herniated discs, for spinal cord cancer;
• subarachnoid hemorrhage– it can be determined in the near future after its appearance. In this case, Kernig's syndrome will show a positive result;
• a tumor on the spinal cord is the main symptom of this disease; pain localized in the direction of the spinal nerve; meningeal syndrome will be a secondary symptom.

Manifestations of Kernig's sign

1. Positive result– in this case, the legs are not able to fully straighten at the knees. This occurs due to spasm in the lower leg muscles. The result suggests that the membranes of the brain are irritated and intracranial pressure is increased.
2. Negative result– manifests itself when the patient has hemiparesis (an increase or decrease in muscle tone, which is unilateral), with neurological diseases (Alzheimer’s or Parkinson’s disease).

What diseases lead to positive Kernig's syndrome?

Liver diseases

In case of pathologies of this organ, a positive reaction of Kernig's symptom is recorded. The fact is that with liver diseases, the amount of bilirubin increases and jaundice appears. These factors lead to meningeal changes, since toxic substances act on brain tissue. The following symptoms are observed in liver diseases:

• forced posture of the patient - arched torso and retracted abdomen;
• the neck muscles become rigid,
• severe headaches caused by increased intracranial pressure;
• the back muscles of the thigh are very tense.

Bacterial infections

A number of diseases that are caused by bacteria lead to meningitis. These include salmonellosis or diphtheria. With these diseases, the patient exhibits a positive Kernig sign, but it is accompanied by other symptoms:

• The patient has a stiff neck;
• the patient is forced to assume the “coping dog” pose - he draws in his stomach, arches his back, and presses his hands to his chest.

General cerebral disorders

Any damage to the brain tissue (due to inflammation, cancer, trauma) causes clinical symptoms. They are usually accompanied by Kernig's sign. General cerebral disorders are characterized by the following symptoms:

These symptoms occur because metabolic, toxic, and vascular changes occur in the brain tissue. They also lead to disorientation in space, hallucinations, and deafness. The extreme degree of cerebral disorders is expressed by coma. In this case, all meningeal syndromes are very pronounced.

Brudzinski syndrome

It represents a group of symptoms that are classified as meningeal. Brudzinski syndrome helps identify whether there is damage to the meninges. This is achieved by provoking the meningeal position.

There are five symptom options:

• • upper symptom Brudzinsky - a person lies on his back, the doctor tries to bring the back of his head closer to his chest. If the patient has damage to the meninges, the back of the head will not drop due to the rigidity of the neck muscles. At the same time, the person will unintentionally bend his legs at the knees and hip joint (as if pulling them towards the chest);
  • buccal symptom consists in the fact that the doctor presses under the patient’s cheekbone. In this case, the patient bends his arm at the elbow on the side from which the pressure occurs. Sometimes the patient raises his wrist;
  • zygomatic sign– it is determined by tapping on the zygomatic arch. At this time, the patient will bend his knees;

• pubic syndrome Brudzinsky - the doctor presses on the pubic area; if there is inflammation of the lining of the brain, the patient will bend his knees;
• lower symptom– the doctor bends the patient’s leg at the knee, at this time the second leg bends involuntarily.

These symptoms were developed by the Polish doctor Joseph Brudzinski. Together with Kernig's symptom, they are used in neurological practice to find out whether the patient's lining of the brain is inflamed.

Lesage's sign

This syndrome allows you to determine whether an infant has meningitis. It consists of taking the infant under the arms and lifting it up. In this state, he pulls his legs to his stomach and holds them in this state, throwing his head back a little. A healthy child in this position will freely bend and straighten his legs.

Causes of meningitis

This disease is infectious in nature. It causes inflammation of the membranes of the brain and spinal cord. Meningitis ranks tenth among all common infections.

Inflammation of the meninges is characterized not only by the Kernig, Brudzinski and Lesage sign. There are a number of other signs of the disease. The illness begins suddenly and is initially similar to the flu. Manifested by the following symptoms:

• severe weakness
• temperature rise to 39 degrees,
• painful sensations throughout the body,
• loss of appetite.

Within a few hours or days, the following symptoms will begin to appear:

• vomit,
• convulsions,
• severe, unbearable pain, which intensifies when turning the head or any noise,
• rashes on the skin,
• strabismus,
• confusion (in severe forms of meningitis).

In this article we tell you how intercostal neuralgia on the left manifests itself.
What symptoms indicate the presence of intercostal neuralgia on the right, read here

At-risk groups

Meningeal syndromes occur in the following groups:

• • In people who have been for a long time received treatment with chemotherapy drugs, cytostatics, and some types of antibiotics;
  • In patients who have undergone or suffering from bacterial infections. For example: toxpolazmosis or echinococcosis, etc.;
  • Predisposed to the disease young children, young and old people;
  • The risk factor is missed vaccination– if a child under 2 years of age has not been vaccinated against mumps, then the likelihood of meningeal syndromes increases;

• People suffering liver diseases, infections caused by bacteria;
• Patients who have been diagnosed cerebral disorders(they can be observed with brain injuries, brain tissue cancer and other inflammations);
• Visiting places (African countries) where there is a high percentage of meningitis, when traveling to such countries it is worth getting the necessary vaccinations.

An important risk factor is genetic predisposition to meningitis and other diseases that lead to meningeal syndromes.

Source: http://zdorovya-spine.ru/bolezni/drugie-zabolevaniya/kerniga.html

Kernig and Brudzinski's sign

Various diseases of the lining of the brain are very dangerous, so it is important to identify them in time and begin treatment. It happens that patients do not immediately see a doctor because of frequent headaches.

But this sign may indicate inflammation, an infection of the brain, or a stroke. For early and accurate diagnosis, most doctors use the Kernig and Brudzinski symptom test.

This allows you to make a correct diagnosis and start treatment on time.

For what symptoms should such a check be carried out?

Brain damage is expressed different signs. The main one is a severe headache. If it continues for a long time or is accompanied by other symptoms, it is necessary to check the patient for Kernig's or Brudzinski's sign. This is necessary to determine in time that inflammation has begun. In what cases is this diagnosis carried out:

• for severe headaches;
• convulsions;
• loss of appetite, nausea and vomiting;
• dizziness;
• disturbances of consciousness;
• increase in body temperature above 39º;
• patient disorientation, lethargy, severe weakness;
• hallucinations;
• stiffness of the neck muscles;
• often the patient takes a forced position - arching his back and drawing in his stomach.

The doctor will definitely check the patient for Kernig and Brudzinski symptoms if he has a severe head or spinal cord injury purulent otitis media or sinusitis, sepsis and some other conditions.

What is Kernig's sign

This is one of important signs, which allows you to diagnose inflammatory diseases of the brain. It is named after the Russian infectious disease doctor Kernig. He was the first to determine how quickly damage to the meninges could be detected. The technique for carrying out this symptom is simple, so it can be performed even at home. What is needed for this:

• place the patient on his back;
• bend one leg at the hip and knee joint to 90º;
• then try to straighten it.

Kernig's sign is considered positive if the leg cannot be straightened. This occurs due to the fact that, due to damage to the meninges during the inflammatory process or hemorrhage, the nerve impulses going to the muscles are disrupted.

And the tone of the flexor muscles is increased. A positive result also indicates increased intracranial pressure and irritation of the meninges. After all, all nerve fibers have a close connection with the brain.

Therefore, the condition of the meninges is often checked based on the functioning of the lower extremities.

If it is impossible to straighten the patient's leg bent at the knee, this indicates damage to the meninges.

What does a positive Kernig sign indicate?

Most often, this reaction accompanies meningeal brain lesions. But the Kernig sign can be positive in other cases:

• with severe liver damage with an increase in the amount of bilirubin;
• some bacterial infections, such as salmonellosis or diphtheria, can also cause brain damage;
• for head injuries leading to hemorrhage or inflammation;
• but sometimes a positive reaction can occur in older people with the lesion skeletal muscles, therefore, in this case, an additional test for Brudzinski’s symptom is used.

Characteristics of Brudzinski's symptom

If you suspect any neurological disorders The reaction to Brudzinski's symptom is checked. It is named after a Polish doctor who studied neurological disorders and was the first to discover a test method that allows timely detection of the presence of an inflammatory process in the membranes of the brain. There are several types of Brudzinsky testing.

• The top symptom is detected with any brain lesions. It is tested like this: the patient lies on his back, he is asked to tilt his head forward and press his chin to his chest. A doctor can do this too. Such a test is considered positive if the patient involuntarily bends his legs, and the chin cannot touch the chest due to spasm of the occipital muscles.
• At purulent meningitis turns out to be positive average symptom Brudzinsky. To check it, you need to press on the pubis of the patient lying on his back. At positive symptom The patient's legs bend involuntarily.
• The check is also often used lower symptom Brudzinsky. To do this, you need to bend the patient's leg at the hip and knee joint. The second leg involuntarily bends with it.

There are several types of diagnostics using the Brudzinsky method

These are the most common verification methods. But sometimes for additional diagnostics a buccal symptom is used, when when pressing on the cheek below the zygomatic arch the patient involuntarily bends his arms, and also a zygomatic symptom - when tapping on the cheekbone, bending of the knees is observed. All these methods can provide the doctor with a complete picture of the condition of the meninges.

What diseases can be detected in this way?

Various pathologies and inflammatory diseases of the brain are quite common. They may be bacterial or viral in nature or caused by other reasons.

But in all cases there will be a positive reaction to the Kernig and Brudzinsky symptom. They may appear weaker or stronger, depending on the nature of the damage to the meninges. It is important that such verification is carried out comprehensively.

Only if several signs are present can a diagnosis be made.

But in any case, with severe headaches, it is advisable to check the patient using the Brudzinsky or Kernig method in order to prevent the development of complications. What diseases can be identified in this way:

• meningitis on early stages;
• subarachnoid hemorrhage in the brain;
• herniated discs;
• spinal cord cancer;
• stroke.

When using such a test, it is possible to recognize the disease at an early stage

What to do if you have a positive reaction to these symptoms

To clarify the diagnosis, the patient must undergo blood tests, CT, MRI or X-ray. This will help to assign correct treatment. It is advisable that it be started as soon as possible, then in many cases the prognosis for recovery will be positive. Features of treatment depend on the identified disease:

• for meningitis - antibiotics, detoxification, restoration of water-salt balance;
• for tumors – surgery or chemotherapy;
• for stroke - neuroprotectors, anticoagulants and other drugs.

Kernig's and Brudzinski's symptoms allow the doctor to make a diagnosis during the first examination of the patient. This is very important for timely detection of the presence of inflammation or hemorrhage in the brain.

Source: http://MoyaSpina.ru/diagnostika/simptom-kerniga-brudzinskogo

Symptoms of meningeal irritation: Kernig, Brudzinsky, Gordon and others

Whatever this phenomenon is called: symptoms of irritation of the meninges (meningeal symptom complex) or meningeal signs, we are always talking about the same process in the brain or spinal cord - the process of intoxication with a disorder in the course of biochemical reactions in the tissues of the higher structures of the nervous system.

And it doesn’t matter at all what agent the intoxication is caused by:

• whether the activity of one’s own chronic microbial infection, “dormant”, but suddenly “awakened” from many years of hibernation at the right moment;
• the “import” of some super-new virus;
• whether a toxic chemical (technical or household) product or allergen has entered the bloodstream.

Because the symptoms will be approximately the same in all cases. And even in the case of mechanical pressure on the meninges, during hemorrhages in one or another part of the brain, toxic products are formed from the destruction of one’s own tissues, leading to a disorder in the fine tuning of nervous processes.

To diagnose neurological pathology, there are many research methods - both clinical, instrumental and laboratory. In turn, among the clinical ones, there are several of the most reliable symptoms of irritation of the meninges, “tested” to brilliance by centuries of medical practice.

The classic syndrome-reflexes of the symptom complex bear the names of the “fathers” of medical science and neurology who discovered them for the first time many years ago: Kernig, Brudzinsky, Gordon and others.

General principles and mechanisms

The essence of the process is that in response to a chemical attack on the meninges located nerve structures the reflex arc closes, accompanied by a muscular reaction from both smooth muscles and skeletal muscles. The response from the latter is especially strong and rudely noticeable, and therefore simply cannot be ignored.

Against the background of the obligatory headaches, excessive sensitivity to sound and light, nausea and vomiting, general weakness and muscle pain, as well as fever and confusion (symptoms that are not at all necessary for meningitis) - phenomena aggravated by tapping on the skull, spine, as well as touching the body, opisthotonus is also inevitably formed.

This is the name of the classic pose, found and adopted by the patient to relieve suffering caused by edematous and inflammatory changes in the affected meninges.

Opisthotonus is a body lying on its side with the head thrown back sharply to the limit, with the legs folded like a penknife and drawn to the stomach and chest, with the arms folded and pressed to the body in a similar way.

Its appearance means it's time to identify pathological reflexes it has arrived.

Brudzinski's signs and neck stiffness

To assess the degree of rigidity of the nuchal muscles, the diagnostic neurologist's hand is placed under the back of the patient's head and the patient's neck is flexed in order to reach the surface of the chest with his chin; the test result is assessed by the distance “traveled” by the head to the specified body level.

This test may not be reliable enough when performed on old people - they have stiff neck muscles due to age, as well as in children.

In addition to neck rigidity - reflexive resistance exerted by tension-bound cervical and occipital muscles to an attempt to bend the patient's head to the chest, the meningeal symptom complex is manifested by Brudzinski's syndromes.

There are four Brudzinski symptoms:

1. Positive superior occipital the symptom is manifested by flexion of the lower extremities in the knee and hip joints with their adduction to the body with an effort to bend the neck and tilt the patient’s head forward.
2. Brudzinski's sign pubic middle– manifested by adduction to the body and flexion of both lower extremities in both the hip and knee joints when pressing on the pubic region.
3. Contralateral(literal translation: on the other side) or the lower version of the symptom is a flexion reflex of the second limb when the thigh of his leg is brought to the patient’s stomach, bent by the diagnostician at the knee joint at a right angle (not completely).
4. At buccal version symptom, pressing on the cheek under the zygomatic arch causes a reflex lifting of both shoulders and folding and bending of both the patient’s arms at the elbow joints. In the version with tapping on the zygomatic arch, a reflex involuntary bending of the legs at the knees occurs.

Kernig reflexes

Increased irritation of the meninges also occurs when checking Kernigie's sign, which is performed in two stages.

After the patient is laid on his back, in the first stage, the neurologist researcher bends the patient's leg at a right angle at both the hip and knee joints.

Then the patient is asked to attempt to straighten the leg at the knee, which causes a reaction of sharp resistance from the muscles that flex the lower leg. A sharp exacerbation of pain in a patient is noticeable to the researcher even when the patient is in an unconscious state - in this case, the second phase of the test is performed by the examining doctor.

In addition to irritation of the meninges due to meningitis, the Kernig sign can be positive and:

At the same time, it can also be negative, as in the case of hemiparesis with an increase or decrease in muscle tone, or in another neurological pathology, Parkinson's disease, for example.

Other symptoms of meningeal irritation

If necessary, also take:

1. Meningeal Guillain's test is a reaction in the form of an involuntary contraction of the quadriceps femoris muscle (m. guadriceps femoris) of the second leg, as a response to compression of the body of the quadriceps muscle of the opposite leg. Is pathognomonic for meningitis, in healthy person this reflex is absent.
2. Diagnostically indicative and valuable is also checking Gordon's symptom, manifested by extension - or dorsal flexion-extension of the big (I) toe when the examining doctor squeezes the muscles of the patient’s lower leg.
3. In addition to reflex muscle - flexor and extensor reactions, increased painful pain when the patient is conscious, it is achieved by pressing on Kerera points. For meningeal condition diagnostic value have trigeminal points (named after the points of exit under the skin of the branches trigeminal nerve these are, respectively, supraorbital, infraorbital and mental), and occipital - occipital. With massive, bilateral diffuse damage to the meninges, the pain will intensify when pressing on the indicated points on both sides of the body, with unilateral damage - only on one side.

Other milestones on the path to diagnosis

In addition to the classic ones, there are other signs and symptoms of irritated meninges, such as:

• Lobzin's test– increased pain when pressure is applied to the wall of the external auditory canal;
• Flatau phenomenon– when the head is tilted forward, the patient’s pupils dilate;
• ankylosing spondylitis test: when percussing the zygomatic arch, the headache intensifies and a reflex contraction of the facial muscles occurs;
• Pulatovsky or craniofacial reflex– the appearance of a grimace of pain even with the most gentle percussion of the skull.

As for children, the most significant are:

• Lesage's sign(or hanging symptom) - a child with meningitis, raised by the armpits, pulls his legs towards his stomach, holding them in this position until he is lowered;
• a symptom called "cracked pot sound", which occurs when percussing a large fontanel in infants, as well as its painful tension and causeless bulging.

One symptom is never enough

Despite the “iron” reliability of the above-mentioned signs - meningeal signs, one should not rely only on them in making a diagnosis, because incorrect diagnosis leads to errors in the tactics of patient management.

Only a specialist - a neuropathologist - can confirm or reject the diagnosis based on an analysis of data from a complex of studies.

• Why do general cerebral symptoms and pathological reflexes appear?

Kernig's sign (reflex, syndrome) is identified by the following signs:

• Bending the leg at an angle of 90 degrees at the knee and hip joints is the first phase;
• Extension of the leg at the knee is the second phase.

The reflex is considered positive when it is impossible to fully extend the knee joint due to a reflex spasm of the skeletal muscles of the lower leg.

Kernig's sign is positive on both sides with meningitis, irritation of the meninges with increased intracranial pressure. It also appears in cases of skull injuries with hematoma (limited accumulation of blood).

The syndrome will be negative if the patient has hemiparesis (unilateral increase or decrease in muscle tone) with neurological diseases(Alzheimer's, Parkinson's).

A physiologically positive syndrome can be observed in elderly patients against the background of degenerative-dystrophic lesions of skeletal muscles.

Differentiate physiological state and pathology will be helped by Brudzinski syndrome, which reveals signs of damage to the meninges by provoking the meningeal posture.

There are 5 options:

• Upper Brudzinski syndrome is positive, when a person cannot bring the head to the chest;
• Zygomatic Brudzinski syndrome is assessed by tapping the zygomatic arch. In this case, bending of the knees will be observed;
• Buccal – the forearms are flexed and the shoulders are raised with pressure on the cheek;
• The positive pubic reflex is characterized by the flexion of the knees when pressing on the pubic area;
• Lower Brudzinski syndrome - when trying to bend the leg at the knee joint, the second leg is brought to the stomach involuntarily. Pathology is observed with meningeal changes.

Kernig's and Brudzinski's signs, when used together, provide the neurologist with information regarding the levels of brain damage.

If the patient has Alzheimer's disease, the appearance of the above reflexes will indicate the degree of degradation of brain tissue.

Liver disease and meningeal reflexes

Liver disease, accompanied by an increase in the amount of bilirubin in the blood and jaundice, leads to meningeal changes due to the toxic effect of the substance on brain tissue. They exhibit the following symptoms:

• Stiff neck;
• Forced pose;
• Tonic tension of the posterior thigh muscles;
• Headaches due to increased intracranial pressure;
• Arched body;
• Intracted stomach.

Jaundice liver disease with bilirubin over 70 µmol/l is accompanied by a pericardial friction rub (“epistenocardiac pericarditis”), which was identified by Botkin. The scientist actively researched hepatitis and determined the specific effect of the virus on the brain. Subsequently, the pathology was named after him - Botkin's disease.

Kernig's syndrome in bacterial diseases

Some bacterial diseases (salmonellosis, diphtheria, shigellosis) lead to inflammatory changes in the meninges. Kernig's symptom against the background of infectious diseases is accompanied by other meningeal signs:

• “Spotting dog” pose - the back is arched, the stomach is retracted, the arms are pressed to the chest;
• Stiff neck.

Kernig and Brudzinski reflex bacterial infections should be distinguished from antalgic resistance of skeletal muscles.

In children, similar signs are observed with parkinsonism and myotonia. Brudzinski's symptoms help determine or exclude the meningeal cause of the pathology.

The syndrome is diagnosed as follows:

• the patient lies on his back, the doctor bends his leg at the hip joint and knee, the flexion angle is ninety degrees;
• at the next stage, the doctor tries to straighten the leg at the knee joint.

If the patient has meningeal syndrome, the lower limb will not fully straighten. This is due to the fact that the tone of the muscles responsible for flexing the legs is increased.

Reasons why Kernig's sign may appear

In medicine, there are the following disorders that cause this condition:
• meningitis - Kernig syndrome diagnoses this disease in the first stages of the disease;
• herniated vertebral discs, spinal cord cancer;
• subarachnoid hemorrhage - it can be detected soon after its appearance. In this case, Kernig's syndrome will show a positive result;
• a tumor on the spinal cord is the main symptom of this disease; pain localized in the direction of the spinal nerve; meningeal syndrome will be a secondary symptom.

Manifestations of Kernig's sign

1. A positive result is that in this case the legs are not able to fully straighten at the knees. This occurs due to spasm in the lower leg muscles. The result suggests that the membranes of the brain are irritated and intracranial pressure is increased.
2. A negative result is manifested when the patient has hemiparesis (an increase or decrease in muscle tone, which is unilateral), with neurological diseases (Alzheimer's or Parkinson's disease).

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What diseases lead to positive Kernig's syndrome?

Liver diseases

In case of pathologies of this organ, a positive reaction of Kernig's symptom is recorded. The fact is that with liver diseases, the amount of bilirubin increases and jaundice appears. These factors lead to meningeal changes, since toxic substances act on brain tissue. The following symptoms are observed in liver diseases:

• forced posture of the patient - arched torso and retracted abdomen;
• the neck muscles become rigid,
• severe headaches caused by increased intracranial pressure;
• the back muscles of the thigh are very tense.

Bacterial infections

A number of diseases that are caused by bacteria lead to meningitis. These include salmonellosis or diphtheria. With these diseases, the patient exhibits a positive Kernig sign, but it is accompanied by other symptoms:

• The patient has a stiff neck;
• the patient is forced to assume the “coping dog” pose - he sucks in his stomach, arches his back, and presses his arms to his chest.

General cerebral disorders

Any damage to the brain tissue (due to inflammation, cancer, trauma) causes clinical symptoms. They are usually accompanied by Kernig's sign. General cerebral disorders are characterized by the following symptoms:

• Strong headache,
• convulsions,
• dizziness,
• impaired functioning of consciousness,
• nausea,
• gagging.

These symptoms occur because metabolic, toxic, and vascular changes occur in the brain tissue. They also lead to disorientation in space, hallucinations, and deafness. The extreme degree of cerebral disorders is expressed by coma. In this case, all meningeal syndromes are very pronounced.

Brudzinski syndrome

It represents a group of symptoms that are classified as meningeal. Brudzinski syndrome helps identify whether there is damage to the meninges. This is achieved by provoking the meningeal position.

There are five symptom options:

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• Brudzinski's pubic syndrome - the doctor presses on the pubic area; if there is inflammation of the lining of the brain, the patient will bend his knees;
• lower symptom - the doctor bends the patient’s leg at the knee, at this time the second leg bends involuntarily.

These symptoms were developed by the Polish doctor Joseph Brudzinski. Together with Kernig's symptom, they are used in neurological practice to find out whether the patient's lining of the brain is inflamed.

This syndrome allows you to determine whether an infant has meningitis. It consists of taking the infant under the arms and lifting it up. In this state, he pulls his legs to his stomach and holds them in this state, throwing his head back a little. A healthy child in this position will freely bend and straighten his legs.

Meningitis

Causes of meningitis

This disease is infectious in nature. It causes inflammation of the membranes of the brain and spinal cord. Meningitis ranks tenth among all common infections.

Meningitis can occur for the following reasons:

• • taking certain types of medications: corticosteroids, immunosuppressants, certain types of antibiotics;
  • furunculosis of the face or neck,
  • the presence of brain tumors or cysts,

Inflammation of the meninges is characterized not only by the Kernig, Brudzinsky and Lesage symptom. There are a number of other signs of the disease. The illness begins suddenly and is initially similar to the flu. Manifested by the following symptoms:

• severe weakness
• temperature rise to 39 degrees,
• painful sensations throughout the body,
• loss of appetite.

Within a few hours or days, the following symptoms will begin to appear:

• vomit,
• convulsions,
• severe, unbearable pain, which intensifies when turning the head or any noise,
• rashes on the skin,
• strabismus,
• confusion (in severe forms of meningitis).

In this article we tell you how intercostal neuralgia on the left manifests itself.
What symptoms indicate the presence of intercostal neuralgia on the right, read here

Characteristics of the syndrome

The Brudzinsky and Kernig determination method consists of identifying early signs of irritation of the meninges by infectious agents or traumatic injuries.

Kernig and Brudzinski syndrome is of particular value, as it allows one to determine the presence of the disease in the early stages, ahead of instrumental and laboratory diagnostics.

The causes of the positive syndrome are diseases such as:

Scientists have been studying the effect of central nervous system damage on patients' primary reflexes for many years. As a result of research, they discovered a relationship between resistance in the muscles of the neck, lower and upper extremities and brain damage.

Kernig syndrome

Developed in the 20th century, the Kernig symptom has not lost its relevance to this day and is an aid in the diagnosis of serious pathologies of the central nervous system.

To check for a positive Kernig sign, the patient is placed on his back and one leg is bent at a right angle at the pelvic and knee joints.

Next, the doctor tries to passively straighten this leg at the knee joint, but this turns out to be impossible due to increased rigidity of the extensors.

This symptom appears on both sides of the patient’s body.

An exception to the rule is those cases when the patient, in addition to damage to the meninges, has paresis - muscle weakening, then the Kernig symptom may not be negative on both or one side of the body.

In old age, flexor muscles are prone to increased tone and contracture. In this case, a false-positive syndrome may be noted.

Brudzinski syndrome

Brudzinsky studied the reflexes of other articular joints with damage to the meninges. To confirm the syndrome, it is necessary to check involuntary flexion of the knee joints with the patient lying on his back.

There are upper, middle, lower Brudzinski syndrome.

The top symptom characterizes an increase in the tone of the neck muscles. When the doctor tries to passively bring the patient's chin to the chest, there is a tightening of the knee joints with simultaneous resistance in the neck.

The middle or pubic positive symptom is detected if, when pressing on the pubic bone, an involuntary flexion movement occurs in the legs.

The lower symptom was developed jointly with Kernig and exactly repeats the previously described phenomenon: when the patient’s leg is passively flexed, it is not possible to straighten it at the knee.

In addition, Brudzinsky noticed that when pressing on the lower point of the zygomatic arch, a person involuntarily contracts the trapezius muscle, pulling the shoulders towards the ears, and also bends the upper limbs at the elbows.

The main thing is not to make mistakes...

It is no coincidence that meningeal signs have this name, since in the vast majority of cases the cause of their manifestation is meningitis. Its different forms are characterized by certain symptoms, but the basis is meningeal.

For meningitis, in addition to inflammatory processes in the brain, noticeable changes occur in cerebrospinal fluid, and this is one of the features of the course of the disease. There are a number of causes that can cause symptoms similar to meningeal syndromes, but do not affect the spinal cord, in particular:

• excessive sunbathing
• excessive saturation of the human body with water (usually occurs after severe dehydration)
• severe infectious diseases (salmonellosis, typhoid, influenza)
• alcohol poisoning
• transient disorder cerebral circulation(PNMC)
• allergies
• brain tumors
• radioactive damage to the body

All of the above can cause the development of meningeal syndrome, but in this situation the treatment differs from the treatment of meningitis.

In addition, there is such a thing as “pseudomeningeal symptoms”, which occur in some diseases that are not associated with damage to the meninges ( mental disorders, osteochondrosis). That is why it is important to take into account all manifestations and make the correct diagnosis.

Classification

It's time to look directly at the symptoms themselves, which are commonly called meningeal. The meningeal symptom complex includes:

a — pointing dog pose, b — Kernig’s sign, c — Brudzinski’s sign

• Kernig's sign
• Brudzinski syndrome
• headache
• vomit
• Bekhterev's symptom
• Gordon's reflex
• Guillain's reflex
• Le Sage syndrome
• stiff neck muscles
• presence of a “pointing dog” pose
• hyperesthesia

To diagnose a syndrome such as Kernig's symptom, the patient is asked to take a supine position, after which the doctor bends his leg at the hip and knee joints at an angle of 90°. Flexion occurs unhindered, but problems arise with extension. So, due to tension in the muscles of the back of the thigh, the patient cannot do this on his own.

Brudzinski syndrome

Brudzinski meningeal syndrome has several variations, including:

1. Buccal.
2. Lower.
3. Upper.
4. Average.

Buccal – the doctor applies pressure to the patient’s cheek, resulting in involuntary flexion of the arms elbow joint, as well as a peculiar shrug.

Lower - With the patient sitting, one of the legs is bent, the second automatically bends along with the first.

Upper – the patient’s head is tilted forward, and the legs are automatically bent.

Medium – when pressing on the patient’s pubis, the legs bend.

Often, Kernig and Brudzinski syndromes occur together in meningitis.

Headache

When meningitis occurs, headache accompanies the patient constantly and does not stop for a minute. It is one of the most pronounced meningeal symptoms.

Vomit

Gag reflexes can occur in a patient even in the absence of such manifestations as primary signs such as nausea. Vomiting occurs suddenly against the background of a severe headache and is characterized by a gushing outpouring.

In some cases, there is a decrease in the intensity of headaches after bouts of vomiting.

Bechterew's syndrome

Meningeal ankylosing spondylitis is diagnosed by tapping the patient's cheekbone with a finger. This tapping causes a severe headache on the side of the face where there is inflammation, in addition, this side will curl up in a grimace of pain.

Gordon's meningeal syndrome is diagnosed by a neurologist as follows: the doctor wraps his hand around the patient's lower leg and applies strong compression. As a result, the patient unclenches thumb legs, and also fingers diverge in different directions.

Guillain reflex

The patient is asked to take a lying position, after which the doctor applies pressure on the front surface of the thigh of one of the legs or squeezes it. As a result, the opposite leg involuntarily bends at the knee.

Lesage syndrome

This symptom is typical for infants, and in most cases it is diagnosed in them. The patient rises up armpits above the floor, as a result of which the baby’s legs involuntarily tighten (pull up to the chest).

Neck muscle stiffness

This condition is characterized by hypertonicity of the occipital and cervical muscles and manifests itself in the inability or difficulty in performing simple actions, such as turning the head or tilting it.

Often, muscle stiffness is characteristic of young children, but not as a symptom of meningitis, but due to the fact that peripheral nervous system not fully formed. Therefore, it is extremely important to diagnose the disease comprehensively and be based on several factors.

Pointing dog pose

In some sources there is such a name as the “cocked hammer” pose. It manifests itself as follows: the patient throws his head back, the torso is tense and elongated, the arms are pressed tightly to the chest, the legs are also pulled up to the thoracic region.

Hyperesthesia

Meningeal hyperesthesia syndrome, or increased light and noise sensitivity, manifests itself in the form of painful perception by the patient of bright light and loud sounds. For this reason, the patient is recommended to stay in a darkened room and, if possible, completely eliminate irritating sounds.

Features of the course of the disease in children

As for children, early age It is difficult to diagnose the disease based on meningeal symptoms, since most of them do not manifest themselves.

The main symptom characteristic of children is Le Sage syndrome, as well as a severe headache, against the background of which the child becomes irritable, refuses to eat and develops apathy.

General principles and mechanisms

The essence of the process is that in response to a chemical attack on the nerve structures located in the meninges, a reflex arc closes, accompanied by a muscular reaction from both smooth muscles and muscles skeletal. The response from the latter is especially strong and rudely noticeable, and therefore simply cannot be ignored.

Against the background of the obligatory headaches, excessive sensitivity to sound and light, nausea and vomiting, general weakness and muscle pain, as well as fever and confusion (symptoms that are not at all necessary for meningitis) - phenomena aggravated by tapping on the skull, spine, as well as touching the body, opisthotonus is also inevitably formed.

This is the name of the classic pose, found and adopted by the patient to relieve suffering caused by edematous and inflammatory changes in the affected meninges.

Opisthotonus is a body lying on its side with the head thrown back sharply to the limit, with the legs folded like a penknife and drawn to the stomach and chest, with the arms folded and pressed to the body in a similar way.

Its appearance means that the time has come to identify pathological reflexes.

Brudzinski's signs and neck stiffness

To assess the degree of rigidity of the nuchal muscles, the diagnostic neurologist's hand is placed under the back of the patient's head and the patient's neck is flexed in order to reach the surface of the chest with his chin; the test result is assessed by the distance “traveled” by the head to the specified body level.

This test may not be reliable enough when performed on old people - they have stiff neck muscles due to age, as well as in children.

In addition to neck rigidity - reflexive resistance exerted by tension-bound cervical and occipital muscles to an attempt to bend the patient's head to the chest, the meningeal symptom complex is manifested by Brudzinski's syndromes.

There are four Brudzinski symptoms:

Increased irritation of the meninges also occurs when checking Kernigie's sign, which is performed in two stages.

After the patient is laid on his back, in the first stage, the neurologist researcher bends the patient's leg at a right angle at both the hip and knee joints.

Then the patient is asked to attempt to straighten the leg at the knee, which causes a reaction of sharp resistance from the muscles that flex the lower leg. A sharp exacerbation of pain in a patient is noticeable to the researcher even when the patient is in an unconscious state - in this case, the second phase of the test is performed by the examining doctor.

In addition to irritation of the meninges due to meningitis, the Kernig sign can be positive and:

• with excessive intracranial pressure;
• with a skull injury;
• in the presence of a hematoma in the brain tissue.

At the same time, it can also be negative, as in the case of hemiparesis with an increase or decrease in muscle tone, or in another neurological pathology, Parkinson's disease, for example.

Other symptoms of meningeal irritation

If necessary, also take:

Sources

• https://spinazdorov.ru/neurology/simptom-kerniga-brudzinskogo.html
• http://zdorovya-spine.ru/bolezni/drugie-zabolevaniya/kerniga.html
• https://revmatolog.org/drugie-zabolevaniya/simptomy-kerniga-i-brudzinskogo.html
• https://nervivporyadke.ru/tsns/meningit/meningealnye-simptomy.html
• http://NeuroDoc.ru/diagnostika/simptomy/razdrazheniya-mozgovyx-obolochek.html

Kernig's sign is named after Vladimir Mikhailovich Kernig, a Russian.

Causes

There are certain types of disorders that can cause Kernig's sign:

• central nervous system (disc herniation or the appearance of tumors in the spinal cord);
• meningitis (Kernig's meningeal sign is detected in the early stages of the disease);
• carina of the sacrolumbar disc (a positive Kernig sign is determined, and sciatic pain occurs on one or both sides);
• spinal cord tumor (the first sign is local pain or painful sensations along the spinal nerve);
• subarachnoid hemorrhage (a few minutes before the onset of hemorrhage, positive Kernig symptoms may appear and).

Diagnostics

Diagnosis of Kernig's symptom is carried out in two phases. The following is done:

1. The patient's legs are bent at the hip and knee joints at an angle of 90 degrees.
2. The legs are extended at the knees.

With a positive Kernig sign, it is impossible to fully straighten the legs at the knee joint. The reason for this is a reflex spasm that occurs in the skeletal muscles of the lower leg. A positive reflex on both sides indicates the presence of meningitis, increased intracranial pressure, which caused irritation of the meninges.

When the Kernig sign is negative, the patient has hemiparesis due to neurological diseases. Elderly people may have a misconception about a positive Kernig sign, especially in the setting of muscle stiffness.

Brudzinski syndrome helps differentiate pathology and physiological conditions. It detects signs of damage to the meninges by provoking the meningeal posture. Kernig's and Brudzinski's signs, when used together, provide information about the extent of brain damage.

Treatment

Regardless of which disease caused the appearance of Kernig's symptom, treatment should only be carried out under the strict supervision of a physician. It is advisable to undergo therapy in a hospital setting. This is very important when treating young children. If you do not follow all the doctor’s recommendations, the consequences can be disastrous and unpredictable. Uncontrolled treatment of diseases with Kernig's symptom or its absence can lead to complete deafness or even death.

To date, there are no methods that make it possible to completely prevent these diseases. True, experts strongly recommend that patients increase their own immunity and undergo preventive examinations in a timely manner.