POSITIVE BRUDZINSKI'S SIGN and Kernig's sign may indicate meningeal irritation and meningitis. Brudzinski's sign is a more sensitive indicator of meningeal irritation than Kernig's sign.

DO

* Keep the environment quiet and dimly lit to avoid stimulating the patient's central nervous system.

* Tell him what you're going to do. Take his vital signs and perform a neurologic assessment including mental status, motor ability, and sensory perception.

* Assess him for headache, fever, light sensitivity, nausea, vomiting, respiratory changes, and signs and symptoms of increasing intracranial pressure, such as changes in pupillary reaction to light, behavior, or level of consciousness.

* Before assessing for Brudzinski's sign, make sure no cervical injury is present. Place your patient in a supine position.

* Assess for nuchal rigidity (neck pain and resistance to flexion), which may signal meningeal inflammation or a mechanical problem.

Figure. [black left pointing small triangle] Place one of your palms behind his head and the other on his chest. Gently try to flex his neck forward by moving his chin toward his chest with the hand behind his head while the other hand keeps his body from rising. Flexion of his knees and hips when you try to flex his neck constitutes a positive Brudzinski's sign. BIRCK COX

* Repeat your assessment on the other side. If pain and resistance to knee extension are bilateral, meningeal irritation may be present.

Figure. [black left pointing small triangle] Keep the patient supine to assess for Kernig's sign. With his hip and knee flexed at 90-degree angles, slowly extend his knee. If he has pain behind the knee and increasingly resists extension, document a positive Kernig's sign. (Slight discomfort behind the knee may be normal, but true pain indicates a positive response.) BIRCK COX

* Correlate your findings with other signs and symptoms of meningitis, and document the patient's responses.

DON'T

* Don't assess for Brudzinski's sign without ruling out cervical trauma or injury.

* Don't force the patient's neck forward to elicit Brudzinski's sign.

* Don't force his hips and knees into flexion to elicit Kernig's sign.

Richard L. Pullen, Jr., is a professor of nursing at Amarillo (Tex.) College. Each month, this department illustrates key clinical points for a common nursing procedure. Because of space constraints, it's not comprehensive.

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