STUDY - Technical - New Dacian's Medicine
brudzinski's
sign (Classical / Allopathic Medicine)
A positive
Brudzinski's sign (flexion of the hips and knees in response
to passive flexion of the neck) signals meningeal irritation.
Passive flexion of the neck stretches the nerve roots, causing
pain and involuntary flexion of the knees and hips.
Brudzinski's sign
is a common and important early indicator of life-threatening
meningitis and subarachnoid hemorrhage. It can be elicited in
children as well as adults, although more reliable indicators
of meningeal irritation exist for infants.
Testing for
Brudzinski's sign isn't part of the routine examination,
unless you suspect meningeal irritation. (See Testing for
Brudzinski's sign.)
ALERT:
If the patient has signs of increased intracranial pressure (ICP), such as altered level of consciousness, pupillary changes, bradycardia, widened pulse pressure, irregular respiratory patterns, vomiting, and moderate fever:
- elevate the head of the bed 30 to 60 degrees
- administer medication (such as an osmotic diuretic or a barbiturate), as ordered
- be prepared to initiate emergency measures.
If the patient doesn't have signs of ICP, perform a focused assessment.
If the patient has signs of increased intracranial pressure (ICP), such as altered level of consciousness, pupillary changes, bradycardia, widened pulse pressure, irregular respiratory patterns, vomiting, and moderate fever:
- elevate the head of the bed 30 to 60 degrees
- administer medication (such as an osmotic diuretic or a barbiturate), as ordered
- be prepared to initiate emergency measures.
If the patient doesn't have signs of ICP, perform a focused assessment.
Testing for
Brudzinski's sign
With the patient in the supine position, place your hands behind her head and lift her head toward her chest.
If your patient has meningeal irritation, you'll observe a positive Brudzinski's sign - the patient's hips and knees will flex in response to the passive neck flexion.
HISTORY:
Ask the patient about headache, neck pain, nausea, and vision disturbances.
Review the patient's medical history for hypertension, spinal arthritis, endocarditis, open head injury, and recent head trauma.
Ask the patient about dental work, abscessed teeth, and I.V. drug abuse.
With the patient in the supine position, place your hands behind her head and lift her head toward her chest.
If your patient has meningeal irritation, you'll observe a positive Brudzinski's sign - the patient's hips and knees will flex in response to the passive neck flexion.
HISTORY:
Ask the patient about headache, neck pain, nausea, and vision disturbances.
Review the patient's medical history for hypertension, spinal arthritis, endocarditis, open head injury, and recent head trauma.
Ask the patient about dental work, abscessed teeth, and I.V. drug abuse.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Evaluate cranial nerve function, noting motor or sensory deficits.
Look for Kernig's sign (resistance to knee extension after flexion of the hip).
Look for signs of central nervous system infection, such as fever and nuchal rigidity.
Take the patient's vital signs.
Evaluate cranial nerve function, noting motor or sensory deficits.
Look for Kernig's sign (resistance to knee extension after flexion of the hip).
Look for signs of central nervous system infection, such as fever and nuchal rigidity.
SPECIAL
CONSIDERATIONS:
Many patients with a positive Brudzinski's sign are critically ill and need constant ICP monitoring and frequent neurologic checks, along with intensive assessments and monitoring of vital signs, intake and output, and cardiopulmonary status.
Many patients with a positive Brudzinski's sign are critically ill and need constant ICP monitoring and frequent neurologic checks, along with intensive assessments and monitoring of vital signs, intake and output, and cardiopulmonary status.
PEDIATRIC
POINTERS:
Brudzinski's sign may not be the most useful indicator of meningeal irritation in infants. More reliable signs - such as bulging fontanels, weak cry, fretfulness, vomiting, and poor feeding - will commonly signal meningeal irritation before you assess for Brudzinski's sign.
Brudzinski's sign may not be the most useful indicator of meningeal irritation in infants. More reliable signs - such as bulging fontanels, weak cry, fretfulness, vomiting, and poor feeding - will commonly signal meningeal irritation before you assess for Brudzinski's sign.
PATIENT
COUNSELING:
Instruct the patient and family on what to expect from diagnostic testing and about emergency measures and equipment that are used. Provide emotional support.
Instruct the patient and family on what to expect from diagnostic testing and about emergency measures and equipment that are used. Provide emotional support.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)