Advanced Assessment in Meningitis

by Stephen Holt, MD, MS

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    00:01 The last thing we're going to do in our comprehensive neurological exam is just take a look at some of the findings that help us to diagnose bacterial meningitis.

    00:07 Because this is such an important condition to diagnose and there are several different tests that folks use at the beside to do that.

    00:15 So, now we're going to look at three specific tests that helps us to look for bacterial meningitis.

    00:20 And all of them involve this idea that when you have bacterial meningitis, there's diffuse inflammation in your meninges and it's particularly within a subarachnoid space and anything we do that tugs on the spinal cord or the spinal nerves is going to irritate in that area and cause the patient discomfort and they may resist whatever motion that we're doing.

    00:40 So, we're going to start off with the Kernig's test and that starts off with just flexing the hip, you can keep your knee flexed.

    00:46 Now, what I'm going to do is just extending the knee, like so.

    00:50 A patient who has bacterial meningitis will resist my extension of his knee because that similar to a straight leg raise.

    00:59 I am stretching the sciatic nerves on heading down his leg.

    01:03 The next test is the Brudzinski's test and it's done in concert with assessing for nuchal rigidity or neck stiffness.

    01:11 So, I'm going to test for neck stiffness and we'll add the Brudzinski portion afterwards.

    01:16 Neck stiffness is very straightforward, it's a passive test, meaning I'm doing the work.

    01:21 I'm just going to lift up your head, Shaun. I'm going to bring it up to your chest.

    01:25 So, bring his chin to his chest.

    01:27 A patient who has nuchal rigidity will resist to that.

    01:30 They will basically extend their neck and resist my flexion of his neck.

    01:34 That would be positive nuchal rigidity which is of the three tests, that's the most useful.

    01:39 The Brudzinski's test would be, if while flexing his neck, he bends his knee, basically, flexes his knee and his hip.

    01:49 That would be - that would basically be the Brudzinski sign.

    01:53 And again, it's a - it has to do with trying to shorten the length of the spinal nerves as I'm flexing his spinal cord around his neck, when I flex his neck.

    02:03 Now, even though I've just gone through those three components, I just want to add that they don't have a lot of specificity or sensitivity and instead, if you're concerned about bacterial meningitis, you're going to have to do that lumbar puncture, anyway.

    02:18 But you'll often times hear by the Kernig and Brudzinski, so I thought it was worth covering to make sure you're familiar with those maneuvers.

    About the Lecture

    The lecture Advanced Assessment in Meningitis by Stephen Holt, MD, MS is from the course Assessment of the Neuromuscular and Neurological System (Nursing).

    Included Quiz Questions

    1. Resistance to the extension of the leg while the hip is flexed
    2. Flexion of the hips and knees in response to neck flexion
    3. Unilateral arm drift when the arms are extended
    4. Severe pain when the neck is flexed

    Author of lecture Advanced Assessment in Meningitis

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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