Meningeal signs: neck stiffness, Kernig and Brudzinski !

Sign

Manoeuvres that look for pain or resistance when inflamed meninges are stretched, as in meningitis.

Updated 2026-11-01

See it in 3D: Dura mater · Spinal cord

What it is

When the meninges are inflamed by infection or blood, stretching them hurts and the muscles contract to protect them. Neck stiffness, the Kernig sign and the Brudzinski sign are the classic manoeuvres to detect this. They are specific but not sensitive: their absence does not rule out meningitis, and the decision to perform a lumbar puncture rests on clinical suspicion.

The anatomy it tests

They test the dura mater, arachnoid and pia mater of the brain and spinal cord.
Flexing the neck, or extending the knee with the hip flexed, stretches the cord, the roots and their meninges.
Reflex muscle contraction protects the inflamed meninges from stretch.

How to elicit it

Neck stiffness: patient lying flat without a pillow; the examiner places the hands behind the head and flexes it gently towards the chest.
Note any resistance or pain and whether the chin fails to reach the chest; then turn the head side to side.
Brudzinski: during neck flexion, watch whether the hips and knees bend by themselves.
Kernig: flex the patient's hip and knee to 90°.
From there, the examiner slowly extends the knee and watches for low back pain or resistance.
Repeat on the other side; wear gloves and apply isolation precautions if bacterial meningitis is suspected.

What a positive result means

Positive: meningeal irritation from bacterial, viral, tuberculous or fungal meningitis, or from subarachnoid haemorrhage.
With fever, headache and confusion they suggest bacterial meningitis and need immediate care.
In subarachnoid haemorrhage, stiffness can take hours to appear.
Their absence does not rule out meningitis.

Usefulness and limits

High specificity and low sensitivity; the diagnosis is confirmed by cerebrospinal fluid analysis.
Cervical osteoarthritis or Parkinson disease limit all neck movements, not just flexion.
In infants, look for a bulging fontanelle, irritability and poor feeding.

Test yourself

Think of the answer, then tap the question to see it.

How is the Kernig manoeuvre performed?

With the patient lying down, flex the hip and knee to 90° and extend the knee; it is positive if this causes pain or resistance.

What is the Brudzinski sign?

Involuntary flexion of the hips and knees when the patient's neck is passively flexed.

Do a negative Kernig and Brudzinski rule out meningitis?

No; they are not sensitive. If clinical suspicion is high, meningitis is still investigated with cerebrospinal fluid analysis.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: Overview of Meningitis (MSD Manual Professional Edition, 2024); Meningitis (MedlinePlus, U.S. National Library of Medicine, 2024).

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Representative model, for educational purposes only.