Brudzinski's Sign

[BushyFromOz]

I ran a pt who was septic with meningitis a few days ago. Signs and symptoms were text book meningits with the esxception of petechial haemorrhgae. What i'd like to know, is how common is brudzinskis signs in these pt's? The pt did flex their neck a bit but stopped due to pain, and i didn't seen any hip flexion when the pt moved their neck, perhaps the test was unsucessful because the felxion was not great enouigh to illicit an response?

Anyway, info would be helpful, my mate google isn't helping much

Cheers

[Monhae]

Brudzinski's neck sign is a neurological reflex associated with inflamation of the meninges. It is one of many indicators to the "possibility" of Meningitis and occurs in less than 50% of pediatric Meningitis cases and less than 10% of Adult cases. Like any sign, it is part of a list of indicators to guide you on your quest for the proper diagnosis or working diagnosis. A bread crumb if you will. The more signs present, the better, but a lack of signs doesn't negate their usefullness. Also remember that this is a reflexive sign. Like any reflex test, it's accuracy is dependant on you illiciting the reflex, not the patient "providing" the reflex. For those not familiar, it is tested by you manipulating the patient's head forward, flexing the neck and observing the patients lower extremities. There should be flexion of the hips and knees in an attempt to raise the lower extremities. Remember were looking for a reflexive response, not an intentional response from the patient.

[kevbutnobacon]

Take it from me son, its common. Oh yes dead common !

Brudzinskis signs once seen never forgotten. Sounds to me that your test was unsuccesssful because the flexion was not great enough to illicit a response.

[BushyFromOz]

occurs in less than 50% of pediatric Meningitis cases and less than 10% of Adult cases.

Cheers, exactly what i was after, thanks

Sounds to me that your test was unsuccesssful because the flexion was not great enough to illicit a response.

Exactly my thoughts, the pt was so stiff in the neck they were unwilling to flex it enough to illicit the response due to pain (if it was going to happen at all)

For interest, ob/presentations was:

started as back pain that radiated to head, followed by severe nause/vomiting for 12 hours. ended up as 7/10 frontal lobe headache, intense photophobia, neck stiffness, PERL, Temp 38.8, B/P 80/60, HR 105, nerologically intact but with hyperasthesia to the backs of both hands and had a histoy of meningitis in the past, so without brudzinski i was very happy with a meningitis and sepsis. They bought themselves 1g of ceftriaxone, 5mg of morph, 3L saline and 20 or so litres of diesel in a hurry.

[Dustdevil]

I'm curious what amount of relief was achieved with the morphine.

[DartmouthDave]

Hello,

Off topic a little. But, it is good to see early abx and aggressive IV therapy for septic patients. On occassion I still see septic patients transfer in with no abx give and little IV fluids given. =(

As for the Brudzinskis signs I have never seen it myself.

Cheers

[Doczilla]

I have seen several cases of bacterial and viral (and one fungal) meningitis and rarely see classic "meningeal signs" such as Koenig's or Brudzinski's.

'zilla

[chbare]

I am with Doc on this one. The cases of true meningitis I have seen were so acutely ill, the emphasis was on stabilizing measures. Seems like these make great test questions however.

[BushyFromOz]

I'm curious what amount of relief was acovered their eyes up betterchieved with the morphine.

very little dusty, and i could have pushed another 15mg of morph, but being wary of bombing the pt's B/P anymore, i chose instead to keep her head stable and cover her eyes up better, this seemed to control her pain more effectively. Pain dropped from 7/10 to 6/10 immediately after the morph, though they did say that it didn't worry them as much, so there was bit of relief. Perhaps fentanyl would have been a better option if i had it?

[OzMedic]

Hey Bushy you wombat rooting, sheep shagging Vexican! Empty your inbox so I can send you a message or send me one with a current email address.