Kernig's sign is seen in: September 2009

Ans. B: Pyogenic Meningitis The main clinical signs that indicate meningism are nuchal rigidity, Kernig's sign and Brudzinski's signs. None of the signs are paicularly sensitive; in adults with meningitis, nuchal rigidity was present in 30% and Kernig's or Brudzinski's sign only in 5%. Nuchal rigidity is the inability to flex the head forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent. Kernig's sign is positive when the leg is fully bent in the hip and knee, and subsequent extension in the knee is painful (leading to resistance).This may indicate subarachnoid haemorrhage or meningitis.Patients may also show opisthotonus --spasm of the whole body that leads to legs and head being bent back and body bowed backwards. The most commonly used sign (Brudzinski's neck sign) is the appearance of involuntary lifting of the legs in meningeal irritation when lifting a patient's head off the examining couch, with the patient lying supine.