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Kernig’s Sign

Other Known Aliases – none

Definition – pain with passive knee extension after placing the hip and knee in flexion

Clinical Significance – This maneuver is due to meningeal irritation and inflammation and can be seen in meningitis, subarachnoid hemorrhage, and encephalitis. It is one of the two classic physical examination signs for bacterial meningitis, but does not have robust sensitivity nor specificity for the disease. It is now relegated to historical context.

History – Named after Vladimir Mikhailovich Kernig (1840-1917), who was a revered Russian internist and neurologist and received his medical doctorate in 1864 the University of Dorpat. He went on to have a prolific teaching career throughout Russia prior to World War I. He published the description of his eponymous finding in 1882 in an article in the St. Petersberg Medizinische Wochenschrift describing cases of findings from patients with bacterial meningitis.

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References

1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
5. Up To Date. www.uptodate.com
6. Mehndiratta M, Nayak R, Garg H, Kumar M, Pandey S. Appraisal of Kernig’s and Brudzinski’s sign in meningitis. Annals of Indian Academy of Neurology. 2012; 15(4):287-8. [pubmed]
7. Thomas KE, Hasbun R, Jekel J, Quagliarello VJ. The diagnostic accuracy of Kernig’s sign, Brudzinski’s sign, and nuchal rigidity in adults with suspected meningitis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2002; 35(1):46-52. [pubmed]
8. Kernig VM (1882). “Ein Krankheitssymptom der acuten Meningitis”. St Petersb Med Wochensch. 7: 398
9. Ward MA, Greenwood TM, Kumar DR, Mazza JJ, Yale SH. Josef Brudzinski and Vladimir Mikhailovich Kernig: signs for diagnosing meningitis. Clinical medicine & research. 2010; 8(1):13-7. [pubmed]