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Brudzinski Sign

What Is It, How It’s Used, and More

Author:Anna Hernández, MD

Editors:Alyssa Haag,Emily Miao, PharmD,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:David G. Walker


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).  

A viral, bacterial, parasitic, or fungal infection typically causes meningitis. The classic triad of meningitis symptoms is nuchal rigidity (i.e., neck stiffness), fever, and headache. If meningitis is suspected, a lumbar puncture can analyze cerebrospinal fluid (CSF) and identify the underlying cause. 

Flexion of neck causing flexion of hips.

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 raised with the knee flexed to a 90-degree angle. Resistance, pain, or inability to extend the knee indicates a positive Kernig sign. 

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Why does the Brudzinski sign happen?

Bruzdinski sign occurs due to meningeal irritation caused by spinal cord movement or nerves against the meninges. It is 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 should not rule 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?

Brudzinski neck sign raises suspicion of meningitis. It can be elicited by flexing the individual’s neck while lying flat on their back. If passive flexion of the neck results in reflex flexion of the hips and knees, it’s a positive sign. A lumbar puncture should be performed if meningitis is suspected. 

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Related links

Anatomy of the cranial meninges and dural venous sinuses
Meningitis
Neisseria meningitidis

Resources for research and reference

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.‌

Hasbun R. Clinical features and diagnosis of acute bacterial meningitis in adults. UpToDate. Accessed April 7, 2023. https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-acute-bacterial-meningitis-in-adults

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