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The last thing we're going to do in our comprehensive neurologic exam is just take a look at
some of the findings that help us to diagnose bacterial meningitis because this is such an
important condition to diagnose and there are several different tests that folks use at the
bedside to do that. So now we're going to look at 3 specific tests that help us to look for
bacterial meningitis and all of them involved this idea that when you have bacterial meningitis
there is diffuse inflammation in your meninges and particularly within the 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. 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." And what I'm going to do is just extending the
knee like so. A patient who has bacterial meningitis will resist my extension of his knee
because that similar to a straight leg raise I am stretching the sciatic nerves heading down
his leg. The next test is the Brudzinski test, and it's done in concert with assessing for nuchal
rigidity or neck stiffness. So, I'm going to test for neck stiffness and we'll add the Brudzinski
portion afterwards. Neck stiffness is very straightforward, it's a passive test, meaning I'm
doing the work. "I'm just going to lift up your head Sean. I'm going to bring it up to your
chest." So bring his chin to his chest. A patient who has nuchal rigidity will resist that, they
will basically extend their neck and resist my flexion of his neck. That would be positive nuchal
rigidity which is of the 3 tests that's the most useful the Brudzinski test would be if while
flexing his neck he bends his knee, basically flexes his knee in his hip, that would basically be
the Brudzinski sign. And again, 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. Now, even though
I've just gone through those 3 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, but you'll oftentimes here about the
Kernig and Brudzinski so I thought it was worth covering to make sure you're familiar with
those maneuvers.