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Brudzinski Sign – Clinical Sign of Meningitis

The Brudzinski sign is a clinical examination finding used to detect meningitis. Passive flexion of the neck causes involuntary flexion of the knees and hips.

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Things worth knowing about "Brudzinski Sign"

The Brudzinski sign is a clinical examination finding used to detect meningitis. Passive flexion of the neck causes involuntary flexion of the knees and hips.

What is the Brudzinski Sign?

The Brudzinski sign is an important neurological examination finding that may indicate meningism or meningitis (inflammation of the meninges, the membranes surrounding the brain and spinal cord). It was named after the Polish pediatrician Józef Brudzinski, who first described it in the early 20th century. Today, it is part of the standard clinical examination when meningitis is suspected.

How is the Brudzinski Sign Tested?

The classic Brudzinski sign (also called the neck sign) is assessed as follows:

The patient lies flat on their back (supine position).
The examiner lifts the patient's head and passively flexes the neck forward (chin toward chest).
The sign is considered positive if the patient involuntarily flexes both knees and hips in response.

There is also the so-called contralateral Brudzinski sign: when one leg is passively flexed at the hip and knee, the other leg flexes involuntarily as well.

Causes and Medical Significance

A positive Brudzinski sign results from irritation or inflammation of the meninges. This irritation triggers a reflex protective response aimed at reducing pressure on the inflamed structures. Common causes of a positive finding include:

Bacterial meningitis (e.g., caused by meningococci or pneumococci)
Viral meningitis (e.g., caused by enteroviruses or herpesviruses)
Subarachnoid hemorrhage (bleeding into the space beneath the arachnoid membrane)
Other forms of meningitis (e.g., tuberculous or fungal meningitis)

Other Signs of Meningism

The Brudzinski sign is typically assessed alongside other clinical signs of meningism:

Kernig sign: The patient cannot fully extend the knee when the hip is flexed.
Nuchal rigidity: Resistance to passive forward flexion of the neck.
Photophobia (sensitivity to light) and phonophobia (sensitivity to sound): Common accompanying symptoms of meningitis.

Diagnosis

The Brudzinski sign alone is not sufficient to definitively diagnose meningitis. It serves as a clinical indicator that prompts further diagnostic workup. A positive finding should lead to the following investigations:

Lumbar puncture (spinal tap): Collection of cerebrospinal fluid (CSF) for analysis of inflammatory cells, bacteria, or viruses
Blood tests: Inflammatory markers such as CRP, procalcitonin, and complete blood count
Imaging: CT or MRI of the head to rule out other causes

When to Seek Emergency Medical Care

A positive Brudzinski sign combined with symptoms such as severe headache, high fever, neck stiffness, altered consciousness, or a skin rash (petechiae) constitutes a medical emergency. Emergency services should be called immediately, as bacterial meningitis can be life-threatening and requires rapid treatment.

References

Haerer, A. F. - DeJong's The Neurologic Examination, 5th edition, Lippincott Williams and Wilkins, 1992.
Attia, J. et al. - Does this adult patient have acute meningitis? JAMA. 1999;282(2):175-181. PubMed PMID: 10411200.
World Health Organization (WHO) - Meningitis. Available at: https://www.who.int/news-room/fact-sheets/detail/meningitis (accessed 2024).

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