Josef Brudzinski and Vladimir Mikhailovich Kernig: Signs for Diagnosing Meningitis

Inf lammation of the meninges, or meningitis, is a serious neurological insult that involves the membranes (dura, pia and arachnoid matter) covering the brain and spinal cord.Meningitis may be caused by any of a host of infectious and noninfectious agents including bacteria, viruses, fungi, parasites, drugs, autoimmune disorders, or malignancy which considerably influences morbidity and mortality.1 Currently, the case-fatality rate for adults with bacterial meningitis is approximately 25% with temporary or permanent neurologic sequelae occurring in 21% to 28% of survivors.2,3 These rates are slightly lower for children older than 1 month, but remain significant, and early diagnosis is critical in improving outcomes.4,5 Symptoms of acute meningitis include high fevers, chills, joint pain, decreased mental status, headache ("worst headache of my life"), stiff neck, photophobia, and rash.Early indicators such as rash or joint pain may present abruptly depending on the etiologic agent.One study reported that initial symptoms appear on average 24 hours prior to hospital admission.6 A major predictor of outcome in patients diagnosed with bacterial meningitis is the time that has elapsed from the onset of symptoms to the initiation of antibiotic treatment.2,7,8 Empiric treatment with selected antibiotics is based on age of the patient and associated co-morbidities.Critical and timely diagnosis may be facilitated by Kernig's and Brudzinski's signs.These two eponyms are commonly associated with meningitis. Kernig's SignVladimir Mikhailovich Kernig (1840-1917) was a Russian-Baltic German clinical neurologist born in Lapaia, Latvia.He received the majority of his education at the Russian University.After receiving his medical doctorate in 1865, Kernig joined the Obuchow Hospital in St. Petersburg as a voluntary assistant physician.He later became a clinical teacher of Internal Medicine at the Empress Marie's institutions, a school for the deaf and mute, and was the head physician at Obuchow Women's Hospital from 1890 until World War I. 9,10