8600 Rockville Pike Kernig-Zeichen (s. Abb. 2014 Jan:32(1):24-8. doi: 10.1016/j.ajem.2013.09.012. Es ist ein Dehnungszeichen des Nervus femoralis, das man bei einer Kompression der Nervenwurzeln L3 bzw. Disclosure: Dov Brandis declares no relevant financial relationships with ineligible companies. Nonetheless, a 2019 study found that despite the variable findings of studies Kernig’s sign can be a useful clinical tool. Calculated effect sizes for each of the studied diagnostic examinations. However, many people with meningitis do not display this sign. 2012 Oct-Dec; 15(4): 287–288. As a conclusion, nuchal rigidity and jolt accentuation tests showed higher sensitivity and lower specificity than Kernig's and Brudzinski's signs. This resistance is thought to be due to meningeal inflammation in the setting of meningitis or oth … It remains a commonly performed maneuver in cases of suspected meningitis. CSF opening pressure is increased in fungal and bacterial infections. Tohoku University Hospital, (https://www.facebook.com/medschoolmadeeasy) Check out our website for TONS OF FREE REV. Since its conception in the 19th century, the clinical value of the Kernig sign has been more thoroughly explored. High specificity suggest when both signs are present there is a high likelihood for meningitis. In this meta‐analysis, we compared the clinical significance and reliability of nuchal rigidity test, jolt accentuation, Kernig's sign, and Brudzinski's sign in the prediction of CSF pleocytosis. Ala A, Rahmani F, Abdollahi S, Parsian Z. Because bacterial meningitis is usually more urgent and fatal than viral meningitis,20, 21 knowing the sensitivity and specificity of each physical examination for each type of the causative microorganism may help clinicians to estimate the risk for bacterial meningitis in the primary care setting. The knee is then slowly extended by the examiner (Repeat on both legs), Step 3. [1] This may indicate subarachnoid haemorrhage or meningitis. high specificity suggest when both sign is present there is a high likelihood for meningitis. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. Journal of general and family medicine. Pediatrics. We thank Dr Satoshi Miyata (Department of Cardiovascular Medicine, Tohoku University Hospital) for his professional comments about the statistical method in the meta‐analysis. Due to its low sensitivity, the absence of the Kernig sign does not rule out meningitis; however, with its high specificity, a positive Kernig sign is highly suggestive of the diagnosis. Negative predictive value 72% When the meninges in the spinal cord and spinal nerves are inflamed, patients will resist stretching the cord and the nerves to prevent pain from this inflammation. 2019 Sep; [PubMed PMID: 31516806], Bilavsky E,Leibovitz E,Elkon-Tamir E,Fruchtman Y,Ifergan G,Greenberg D, The diagnostic accuracy of the 'classic meningeal signs' in children with suspected bacterial meningitis. [8] In meningitis, there is hypertonia of lower limbs and increased sensitivity of lower limb nerves. The differential diagnoses in the presence of positive signs include spinal cord tumors, myelitis, intervertebral disc prolapse, sciatica, multiple sclerosis, trauma, subarachnoid hemorrhage, and increased intracranial pressure from numerous causes or in the setting of stroke. Was ist Kernig Zeichen? Therefore, the objective assessment of the usefulness of jolt accentuation based on previous clinical studies worldwide is required. Differences in the thresholds to judge positivity in these physical examinations among the clinicians might be one of the candidate causes, but not conclusive. Accessibility Etiology and mortality of bacterial meningitis in northeastern Brazil. Brudzinski’s sign is noted when a person's knees and hips reflexively bend when their head is raised from the table while lying face up. To check for Kernig’s sign, a healthcare provider will: Kernig’s sign is often used with Brudzinski’s, another clinical sign of meningitis. 1173185. 2017 Oct 30; [PubMed PMID: 29084605], Feel free to get in touch with us and send a message. Vorwiegend dient das Kernig Zeichen dem Test des Meningismus, aber wenn dieser negativ ausfällt und es neurologische Nervenschäden sind, dann kann der Test auch darauf, wie im Video auf YouTube zu sehen, angewandt werden. - Parasiten (Echinokokkose, Toxoplasmose). When refering to evidence in academic writing, you should always try to reference the primary (original) source. The specificity of jolt accentuation was 82%, Kernig sign was 97%, Brudzinski sign was 98%, and nuchal rigidity was 80%. Kernig sign is one of the eponymous clinical signs of meningitis. Regelmäßige News und Fachbeiträge zu allen relevanten Themen aus dem Bereich Gesundheit und Medizin vermitteln kostenlos Wissen. Literatur. The examiner then passively extends the legs. Die Meningitis ist eine Entzündung der Hirn- und Rückenmarkshäute, wobei die Abgrenzung einer isolierten Meningitis zu einer kombinierten Entzündung von Hirnhäuten und Hirngewebe ( Meningoenzephalitis) insb. Bryan JP, de Silva HR, Tavares A, Rocha H, Scheld WM. In contrast to jolt accentuation, nuchal rigidity can be applied even in the patients with disturbed consciousness. As an alternative diagnostic maneuver with relatively high sensitivity, jolt accentuation was introduced in the late 20th century.4 The maneuver of jolt accentuation involves head rotation at a frequency of 2‐3 times per second and examining whether the headache exacerbates or not. Based on the present study, the suggested sensitivity of jolt accentuation in meningitis diagnosis would be around 40%‐60%, far lower than originally reported. The following videos offer an intro to Anki as a study tool—tips on how to most effectively use Anki throughout med school, foundational study techniques to combine AMBOSS and Anki, and an exclusive look into the Anki Mastery Course—all delivered by the ultimate Anki expert: the AnKing. Der Winkel, bei dem der Schmerz eintritt, sollte dokumentiert werden. 4.61c) Patient liegt mit 90° im Hüftgelenk und 90° im Kniegelenk angewinkeltem Bein auf dem Rücken, dann passive Beinstreckung im Kniegelenk. HHS Vulnerability Disclosure, Help In conclusion, odds ratio, sensitivity, and specificity in predicting CSF pleocytosis are almost similar between jolt accentuation and nuchal rigidity tests. 2013 Nov; [PubMed PMID: 24070978], Curtis S,Stobart K,Vandermeer B,Simel DL,Klassen T, Clinical features suggestive of meningitis in children: a systematic review of prospective data. Emily is a health communication consultant, writer, and editor at EVR Creative, specializing in public health research and health promotion. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed. The maneuver was performed with the patient seated upright with the hips flexed 90 degrees to the trunk. Die zweite Durchführung findet im Sitzen statt. AMBOSS, Wissen – von Medizinern für Mediziner. This test is typically performed in patients while supine and is described as resistance (or pain) with passive extension of the knees. The test is also unreliable for very lethargic, paraplegic, or comatose patients because these individuals may not have obvious meningeal signs. Sendai, Before [1] Image: Overview of the meninges of the brain (coronal view) [2] Purpose Kernig's sign is used to diagnose meningitis Technique Japan, 4 [9] A positive Kernig sign patient should undergo a CT scan followed by a . #ambossmed #auditor #Virushepatitiden #Serologie Overview of the study design. http://www.nlm.nih.gov/medlineplus/ency/imagepages/19077.htm, https://www.kenhub.com/en/library/anatomy/meninges-of-the-brain-and-spinal-cord. This is especially important for bacterial meningitis as it can be life-threatening and requires immediate treatment. In dieser Auditorfolge schauen wir uns einmal die verschiedenen Virushepatitiden genauer an. The thought is that these findings are due to mechanical factors in the spine. [1], Image: Overview of the meninges of the brain (coronal view)[2], Kernig's sign is used to diagnose meningitis, Step 1. National Library of Medicine On the other hand, Kernig's sign method did not reach statistical significance with odds ratio of 2.37 (99% CI: 0.76‐7.36, P = 0.05). Confusion, agitated delirium, and stupor are rarer; however, coma is . siehe auch: Brudzinski-Zeichen, Kernig-Zeichen Stichworte: Dehnungsschmerz, Eponym, Ischialgie, Klinisches Untersuchungsverfahren, Klinisches Zeichen, Lasègue Fachgebiete: Neurologie, Orthopädie BY-NC-SA Symptoms of meningitis may accompany the petechiae of meningococcemia and may produce the predominant features on presentation. Es geht vorwiegend darum in diesem Test zu prüfen, ob eine Meningitis aufgetreten ist. Aus diesem Anlass ist die neurologische Untersuchung in Form des Kernig Zeichen noch immer beliebt. Tamune H, Takeya H, Suzuki W, Tagashira Y, Kuki T, Nakamura M. Absence of jolt accentuation of headache cannot accurately rule out meningitis in adults. Die Frage kommt gar nicht selten vor, aber schauen Sie gerne mal im Netz nach, wie oft die Frage „was ist Kernig Zeichen“ dort wirklich vorkommt. Therefore, babies who are highly irritable or tense do not make good candidates for the test. Kernig described a positive sign as the inability to extend the knees more than 135 degrees. Epub 2018 Jan 20. Considering the above, together with the fact that the suggested sensitivity and odds ratio of jolt accentuation were as high as those of nuchal rigidity, jolt accentuation would be another useful and reliable diagnostic physical examination test to predict CSF pleocytosis. Wartezimmeronline © 2022. Examiners can perform this maneuver alone without any helpers. Alle Rechte vorbehalten. Accessibility 2013 Nov;31(11):1601-4. This resistance is thought to be due to meningeal inflammation in the setting of meningitis or other clinical entities that may irritate the meninges. Hier muss der Patient sich gerade, wie auf Bilder im Netz zu sehen, hinlegen. The .gov means it’s official. The jolt accentuation maneuver, described more recently in 1993, is a bedside maneuver to identify cases of meningitis with exacerbation of a headache caused by rotation of the head horizontally two or three times per second. Chapter 28: a history of bacterial meningitis. In bacterial and fungal infections, glucose is reduced in CSF. Kernig-Zeichen, Lasègue-Zeichen. Copyright © 2023, StatPearls Publishing LLC. Meningitis is an important disease entity that carries high morbidity and mortality rates, requiring early recognition and management. Department of Neurology, Community Flexikon Shop News Jobs CME. Definition Der Begriff Meningismus bezeichnet eine Schmerzhaftigkeit und einen erhöhten Bewegungswiderstand bei der passiven Beugung des Kopfes, die durch eine Reizung der Hirnhäute (Meningen) ausgelöst werden. Am Fam Physician. The calculated scores for the heterogeneity of the enrolled studies and the calculated odds ratios with their 99% CIs are summarized in Table Table2.2. Als zusätzliche Reizsymptome der Meningen können Übelkeit, Erbrechen sowie Fotophobie hinzutreten. By Emily Brown, MPH Further, there is no correlation between the Kernig sign and the severity of meningeal inflammation. Of course, a positive test must correlate with clinical and laboratory features. Kernig’s sign is a useful tool to help a healthcare provider reach a meningitis diagnosis. In most cases Physiopedia articles are a secondary source and so should not be used as references. Gently flex the neck, bringing chin to chest, Step 4. Therapeutic advances in neurological disorders. In severe cases, patients could not extend their knees past 90 degrees. -, Forgie SE. Nevropatologiia i psikhiatriia. There are some limitations in this study. Kernig sign was initially described in the 19th century by Russian physician Vladimir Kernig. Disclaimer. Kernig's should not be relied on when meningitis is suspected and a lumbar puncture should be performed. Ala A, Rahmani F, Abdollahi S, Parsian Z. Emerg (Tehran). Nine studies, comprising a total of 599 patients with pleocytosis in the cerebrospinal fluid (CSF) and 1216 patients without CSF pleocytosis, were enrolled in the analysis. 2020;105(1):46-49. doi:10.1136/archdischild-2018-315428. It is one of the clinical signs used by healthcare providers to diagnose meningitis. In: StatPearls [Internet]. Given its simplicity, Kernig’s sign can help detect meningitis early on, so treatment can start as soon as possible. . Mehndiratta M, Nayak R, Garg H, Kumar M, Pandey S. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. 2010;95:417-33. doi: 10.1016/S0072-9752(08)02128-3. Federal government websites often end in .gov or .mil. Meningitis is typically caused by a viral infection, but it can also result from bacterial, parasitic, or fungal infections. Dazu werden weitere Tests angestrebt und die Problematik genauer durchleuchtet. Psychrembel - Brudzinski-Zeichen, abgerufen am 15.11.2021; MeSH As a result, a total of nine studies were considered as eligible for the subsequent meta‐analysis.4, 5, 6, 7, 8, 9, 10, 11, 12 Moreover, we confirmed that there was no report of meta‐analysis that assessed or compared the usefulness of nuchal rigidity and jolt accentuation tests. Details of the enrolled nine case‐control studies are summarized in Table Table11. Akaishi T, Kobayashi J, Abe M, et al. The threshold of positivity in each of the four physical examination tests could have varied among the clinicians and affected the results. Appraisal of Kernig's and Brudzinski's sign in meningitis, http:///index.php?title=Kernig%27s_Sign&oldid=299030, Low sensitivity suggest when both signs absent should not conclude that there is no evidence of meningitis. The PRISMA statement for reporting systematic reviews and meta‐analyses of studies that evaluate health care interventions: explanation and elaboration. First, most of the previous studies that assessed the usefulness of jolt accentuation were reported mainly from groups in Japan and Iran. . Accuracy of Neck stiffness, Kernig, Brudzinski, and Jolt Accentuation of Headache Signs in Early Detection of Meningitis. Als definierte Aussage wie auch im Amboss der Ärzte zu erkennen ist, reicht die Aussage, dass das Kernig Zeichen eine neurologische Untersuchung ist doch hoffentlich aus oder? Kernig sign. 6th edition. Die Durchführung des Kernig Zeichen Es gibt zwei unterschiedliche Ausführungsarten des Kernig Zeichen. Mofidi M, Negaresh N, Farsi D, Rezai M, Mahshidfar B, Abbasi S, et al. Available from: Overview of the meninges of the brain (coronal view) image - © Kenhub, Brunner & Suddarth's Textbook of Medical-surgical Nursing, Volume 1. edited by Suzanne C. O'Connell Smeltzer, Brenda G. Bare, Janice L. Hinkle, Kerry H. Cheever. Kernig’s sign is a clinical indication that meningitis may be present. The presence of contracture or extensor spasm at the knee was considered a positive finding. the contents by NLM or the National Institutes of Health. An official website of the United States government. doi: 10.4103/0972-2327.104337. 2013 Oct; [PubMed PMID: 22914116], Stribos MP,Jones EB, Brudzinski Sign 2020 Jan; [PubMed PMID: 30969733], MEITUS SS, [Induction of Kernig symptoms in children in practice]. Welche Erreger kommen in Frage? Sendai, Josef Brudzinski and Vladimir Mikhailovich Kernig: signs for diagnosing meningitis. sharing sensitive information, make sure you’re on a federal Prüfung Der Patient wird flach auf dem Rücken gelagert. Ann Indian Acad Neurol. However, the signs have specificities of 95% and are considered highly predictive of bacterial meningitis when present in the appropriate clinical setting. The patient is positioned in supine with hip and knee flexed to 90 degrees, Step 2. Kernig's sign is a test used in physical examination to look for evidence of irritation of the meninges. 2014 Jan;32(1):24-8. doi: 10.1016/j.ajem.2013.09.012. This resistance is thought to be due to meningeal inflammation in the setting of meningitis or other clinical entities that may irritate the meninges. This test is typically performed in patients while supine and is described as resistance (or pain) with passive extension of the knees. Auf der Liege am Rand darf sich der Patient nun positionieren und muss seine Hüften am Rand um 900 beugen. While a positive Kernig’s sign alone does not guarantee a meningitis diagnosis, it, along with a positive Brudzinski’s sign, increases the likelihood of a meningitis diagnosis. 10.1002/jgf2.268 Kernig's sign is often looked for along with Brudzinski's sign when someone is suspected of having meningitis. When combined with a patient's medical history, other examinations, and diagnostic tests, Kernig’s sign contributes to a comprehensive diagnostic assessment for meningitis. Kernig described a positive sign as the inability to extend the knees more than 135 degrees. The Brudzinski nape of the neck sign was described in 1909 by Polish pediatrician Brudzinski. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. 2010 Nov; [PubMed PMID: 20974781], Attia J,Hatala R,Cook DJ,Wong JG, The rational clinical examination. A careful review of clinical history and symptoms, together with the meningeal signs, is necessary to decrease the risk of misdiagnosis. Die Beine werden bei gestrecktem Knie im Hüftgelenk gebeugt. Because of the simultaneous comparisons, we considered a P‐value lower than 0.01 to be significant in this study. [9], A positive Kernig sign patient should undergo a CT scan followed by a lumbar puncture and antibiotics. Orthopedic Physical Assessment. Kernig’s sign is named after neurologist and neurologist Vladimir Mikhailovich Kernig, who described the first signs of meningitis. 2018;6(1):e8. With a scientific background and a passion for creative writing, her work illustrates the value of evidence-based information and creativity in advancing public health. 2014. Kernig-Zeichen) oder eine Kiefersperre beitragen. Vigil KJ, Salazar L, Hasbun R. Community-Acquired Meningitis in HIV-Infected Patients in the United States. This test is typically performed in patients while supine and is described as resistance (or pain) with passive extension of the knees. Because the correct assessment of nuchal rigidity is not always easy for the clinicians, jolt accentuation would be a helpful supplementary physical examination to avoid misdiagnosing meningitis. 2012 Oct; [PubMed PMID: 23349594], Hersi K,Gonzalez FJ,Kondamudi NP, Meningitis 2020 Jan; [PubMed PMID: 29083833], Akaishi T,Kobayashi J,Abe M,Ishizawa K,Nakashima I,Aoki M,Ishii T, Sensitivity and specificity of meningeal signs in patients with meningitis. Mehr zu den Virushepatitiden findet ihr auch bei AMBOSS unter:https://go.amboss.com/auditor-hahttps://go.amboss.com/auditor-hbhttps://go.amboss.com/auditor-hcInhalt:00:00 – Allgemeines01:36 – Hepatitis A03:52 – Hepatitis B06:13 – Hepatitis C08:20 – Hepatitis D11:06 – Hepatitis EAMBOSS ist das ideale Nachschlagewerk für Ärztinnen und Ärzte im klinischen Alltag und das perfekte Lernsystem für Medizinstudierende. Epub 2013 Oct 16. The https:// ensures that you are connecting to the [10], The primary use of performing the Kernig sign in a patient is in the diagnosis of suspected meningitis. Die eine Vorgehensweise findet derweil im Liegen statt. [4], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. siehe auch: Brudzinski-Zeichen, Kernig-Zeichen. Tohoku Medical and Pharmaceutical University, Department of Neurology, Likewise, the absence of Kernig’s and Brudzinski’s signs is reassuring, but it does not totally exclude meningitis from the list of conditions that may be going on if someone has meningitis-like symptoms. 2016 Jul;35(7):749-51. doi: 10.1097/INF.0000000000001152. Japan, 2 Thus, if a clinician can correctly assess the nuchal rigidity, this would be the most useful physical examination to diagnose meningitis. https://www.amboss.com/de Viren gehören zu den häufigsten Auslösern einer Hepatitis. [4]. Regarding the specificity of the physical examination tests, the provisional overall specificity was 71.3% (727/1020) for nuchal rigidity, 71.1% (505/710) for jolt accentuation, 91.2% (819/898) for Kernig's sign, and 88.8% (663/747) for Brudzinski's sign. And also patients with severe meningitis on the basis of laboratory evidence both Kernig's sign and Brudzinski's sign as low diagnostic value. Kernig also described instances where patients could not extend their elbows in cases of meningitis. Undoubtedly, the most popular and prevailing physical examination is nuchal rigidity. Waghdhare S, Kalantri A, Joshi R, Kalantri S. Accuracy of physical signs for detecting meningitis: a hospital‐based diagnostic accuracy study. Verywell Health's content is for informational and educational purposes only. Pediatr Infect Dis J. Das Zeichen tritt bei funktioneller Diskonnektion des (intakten) Mittelhirns auf und dient als Indikator für schwere beidseitige supratentorielle oder zumindest dienzephale Funktionsstörungen. Looking for Kernig’s sign is simple and effective, which makes it a useful clinical tool to help diagnose meningitis. Ver traducciones en inglés y español con pronunciaciones de audio, ejemplos y traducciones palabra por palabra. The clinical signs associated with meningitis, including Kernig and Brudzinski, correlate with other diseases. The History and Current Relevance of the Eponymous Signs of Meningitis. Rather, Kernig’s sign is a tool in a toolbox to help narrow down the causes when someone has meningitis-like symptoms. Full-text search Full-text search; Author Search; Title Search; DOI Search The results are mixed due to inconsistencies in standards used and low sample sizes, limiting these studies' findings. We systematically reviewed studies on the above‐mentioned physical examination tests and performed meta‐analysis of their diagnostic characteristics to evaluate the clinical usefulness. NEU: Log dich ein, um Artikel in persönlichen Favoriten-Listen zu speichern. Kernig’s sign is a physical indicator used by healthcare providers to diagnose meningitis. Otherwise, patients with meningitis could be misdiagnosed. However, the easiness in the performance and interpretation of jolt accentuation, even by physicians other than neurologists, is attractive and desired to be reconsidered. Elicitation of the Kernig sign often is performed in conjunction with other examination techniques to detect meningitis in symptomatic patients, particularly the Brudzinski sign. The calculated scores for the heterogeneity of the enrolled studies and the calculated odds ratios with their 99% CIs are summarized in Table Table2. 2012;15(4):287-288. doi:10.4103/0972-2327.104337, Tracy A, Waterfield T. How to use clinical signs of meningitis. 8600 Rockville Pike That is usually the journal article where the information was first stated. sharing sensitive information, make sure you’re on a federal Abbreviations: BS, Brudzinski's sign; JA, jolt accentuation; KS, Kernig's sign; NR, nuchal rigidity; (+), evaluated; (−), not evaluated. A positive Brudzinski sign refers to the maneuver in which the clinician passively flexes the neck, resulting in the flexion of the hips and the knees of the patient.[13]. This physical symptom was named Kernig’s sign and was first published in medical literature in 1882. Neben dem Kernig Zeichen gibt es zum Beispiel auch den Brudzinski Test oder das Laségue-Zeichen. Als umgekehrtes Lasègue-Zeichen oder umgekehrter Lasègue bezeichnet man die Schmerzauslösung bei Überstreckung des gestreckten Beines im Hüftgelenk.
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