STUDY - Technical - New Dacian's Medicine
Kernig's sign (Classical / Allopathic Medicine)
A reliable early
indicator of meningeal irritation, Kernig's sign elicits
resistance and hamstring muscle pain when the examiner
attempts to extend the knee while the hip and knee are
flexed 90 degrees. (See Eliciting Kernig's sign.) This sign
is usually positive in patients with meningitis or
subarachnoid hemorrhage. With these potentially
life-threatening disorders, hamstring muscle resistance
results from stretching the blood- or exudate-irritated
meninges surrounding spinal nerve roots.
Kernig's sign
can also indicate a herniated disk or spinal tumor. In these
disorders, sciatic pain results from disk or tumor pressure
on spinal nerve roots.
ALERT:
If you elicit a positive Kernig's sign:
- take the patient's vital signs
- test for Brudzinski's sign to obtain further evidence of meningeal irritation
- prepare for emergency intervention.
If you don't suspect meningeal irritation, perform a focused assessment.
If you elicit a positive Kernig's sign:
- take the patient's vital signs
- test for Brudzinski's sign to obtain further evidence of meningeal irritation
- prepare for emergency intervention.
If you don't suspect meningeal irritation, perform a focused assessment.
HISTORY:
Ask the patient if he feels back pain that radiates down one or both legs. Does he also feel leg numbness, tingling, or weakness?
Review the patient's medical history for cancer and back injury.
If you suspect meningitis, proceed with these steps:
Ask the patient or his family to describe the onset of illness.
Ask the patient or his family about recent infections, especially tooth abscesses or exposure to persons infected with meningitis.
Ask the patient or his family about other signs and symptoms, such as headache, confusion, fever, and nuchal rigidity.
Review the patient's medical history for open-head injury and endocarditis.
Ask the patient or his family about a history of I.V. drug use.
If you suspect subarachnoid hemorrhage, proceed with these steps:
Review the patient's medical history for hypertension, cerebral aneurysm, head trauma, and arteriovenous malformation.
Ask the patient or his family about sudden withdrawal of an antihypertensive.
Ask the patient if he feels back pain that radiates down one or both legs. Does he also feel leg numbness, tingling, or weakness?
Review the patient's medical history for cancer and back injury.
If you suspect meningitis, proceed with these steps:
Ask the patient or his family to describe the onset of illness.
Ask the patient or his family about recent infections, especially tooth abscesses or exposure to persons infected with meningitis.
Ask the patient or his family about other signs and symptoms, such as headache, confusion, fever, and nuchal rigidity.
Review the patient's medical history for open-head injury and endocarditis.
Ask the patient or his family about a history of I.V. drug use.
If you suspect subarachnoid hemorrhage, proceed with these steps:
Review the patient's medical history for hypertension, cerebral aneurysm, head trauma, and arteriovenous malformation.
Ask the patient or his family about sudden withdrawal of an antihypertensive.
Eliciting
Kernig's sign
To elicit Kernig's sign, place the patient in a supine position. Flex her leg at the hip and knee, as shown here. Then try to extend the leg while you keep the hip flexed. If the patient experiences pain and possibly spasm in the hamstring muscle and resists further extension, you can assume that meningeal irritation has occurred.
PHYSICAL ASSESSMENT:
Perform a neurologic assessment, including pupil reaction and size and level of consciousness. Test for hemiparesis, aphasia, and sensory or visual disturbances.
Assess the patient for signs of increasing intracranial pressure (ICP), such as bradycardia, increased systolic blood pressure, respiratory pattern change, and widened pulse pressure.
Assess the patient's motor and sensory function.
To elicit Kernig's sign, place the patient in a supine position. Flex her leg at the hip and knee, as shown here. Then try to extend the leg while you keep the hip flexed. If the patient experiences pain and possibly spasm in the hamstring muscle and resists further extension, you can assume that meningeal irritation has occurred.
PHYSICAL ASSESSMENT:
Perform a neurologic assessment, including pupil reaction and size and level of consciousness. Test for hemiparesis, aphasia, and sensory or visual disturbances.
Assess the patient for signs of increasing intracranial pressure (ICP), such as bradycardia, increased systolic blood pressure, respiratory pattern change, and widened pulse pressure.
Assess the patient's motor and sensory function.
SPECIAL
CONSIDERATIONS:
If the patient has a subarachnoid hemorrhage, darken the room and elevate the head of the bed at least 30 degrees to reduce ICP. If he has a herniated disk or spinal tumor, he may require pelvic traction.
If the patient has a subarachnoid hemorrhage, darken the room and elevate the head of the bed at least 30 degrees to reduce ICP. If he has a herniated disk or spinal tumor, he may require pelvic traction.
PEDIATRIC
POINTERS:
Kernig's sign is considered ominous in children because they have a greater potential for rapid deterioration.
Kernig's sign is considered ominous in children because they have a greater potential for rapid deterioration.
PATIENT
COUNSELING:
Provide emotional support to the patient and his family during all diagnostic tests and treatments. Refer them for spiritual support, if appropriate.
Provide emotional support to the patient and his family during all diagnostic tests and treatments. Refer them for spiritual support, if appropriate.
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)