Brudzinski Sign · What Is It, How It’s Used, and More

Published: Nov 19, 2025
Author: Anna Hernández, MD•
Editor: Alyssa Haag, MD•
Editor: Emily Miao, PharmD•
Editor: Kelsey LaFayette, DNP, ARNP, FNP-C
Illustrator: Jessica Reynolds, MS•
Copyeditor: David G. Walker
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What is the Brudzinski sign?

The Brudzinski sign is one of the physical maneuvers used to evaluate an individual for a suspected case of meningitis, a condition characterized by inflammation of the meninges (i.e., the protective membranes surrounding the brain and spinal cord).   

 Meningitis can be caused by either a viral, bacterial, or fungal infection. The classic triad of meningitis symptoms is nuchal rigidity (i.e., neck stiffness), fever, and headache, though these symptoms may not always be present. If meningitis is suspected, a lumbar puncture is often performed in order to analyze the cerebrospinal fluid (CSF) and identify the underlying etiology. A lumbar puncture is often obtained prior to administering treatment, as this increases the diagnostic yield.  

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How is the Brudzinski sign performed?

Brudzinski sign is performed with the individual lying flat on their back. The examiner then places one hand behind the individual’s head and the other on their chest to prevent them from rising. A positive Brudzinski sign is considered when neck flexion causes the individual to flex their hips and knees automatically. 

The Brudzinski sign is often performed with the Kernig sign. To elicit the Kernig sign, a leg is extended with the knee flexed to a 90-degree angle. Resistance, pain, or inability to extend the knee indicates a positive Kernig sign.  

What causes a positive Brudzinski sign?

Bruzdinski sign occurs when inflamed meninges are irritated by spinal cord movement or nerves against the meninges. It’s thought that passive neck flexion stretches the nerve roots through the inflamed meninges, leading to reflex flexion of hips and knees to relieve the pain.  

What are the limitations of the Brudzinski sign?

Negative Brudzinski and Kernig signs are insufficient in ruling out meningitis. The Brudzinski and Kernig signs were described over a century ago in individuals with severe, late-stage tuberculous and bacterial meningitis. Several studies have shown low sensitivity to Kernig and Brudzinski signs to detect meningitis. Nonetheless, because of their high specificity, if Kernig or Brudzinski sign is present, meningitis is likely.  

What are the most important facts to know about the Brudzinski sign?

A positive Brudzinski sign raises suspicion of meningitis. It can be elicited with the individual lying supine and passively flexing their neck. If passive flexion of the neck results in reflex flexion of the hips and knees, it’s a positive sign. If positive, a lumbar puncture should be performed to confirm the diagnosis of meningitis.  

Key Takeaways

Definition 

A physical maneuver used to evaluate an individual for a suspected case of meningitis.

 

Perform 

-How 

     -Lie flat on back 

     -Place one hand behind patient’s head and the other on their chest 

          -Positive Brudzinski sign: neck flexion causes patient to flex their hips and knees 

-Often performed with the Kernig sign 

     -To elicit the Kernig sign: extend leg with the knee flexed to a 90-degree angle 

           -Positive Kernig sign: Resistance, pain, or inability to extend the knee 

Causes 

-Inflamed meninges irritated by spinal cord movement or nerves against the meninges 

-Passive neck flexion stretches nerve roots through inflamed meninges 

     -Causes reflex flexion of hips and knees to relieve pain 

Limitations 

-Negative Brudzinski sign does not rule out meningitis 

-Low sensitivity for positive Brudzinski sign to detect meningitis 

Interventions 

-Positive sign 

     - Lumbar puncture 

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References

2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Tunkel AR, Hasbun R, Bhimraj A, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR. Clin Infect Dis. 2017.


Ala A, Rahmani F, Abdollahi S, Zahra Parsian. Accuracy of neck stiffness, Kernig, Brudzinski, and jolt accentuation of headache signs in early detection of meningitis. Emergency. 2018;6(1):e8-e8.‌


Mehndiratta M, Nayak R, Garg H, Kumar M, Pandey S. Appraisal of Kernig`s and Brudzinski′s sign in meningitis. Annals of Indian Academy of Neurology. 2012;15(4):287. doi:https://doi.org/10.4103/0972-2327.104337