For a number of years I have noted in cases of meningitis a sign that appears to be little known although its practical value is, in my opinion, not insignificant. I refer to the occurrence of flexion in the legs, and sometimes in the arms as well, when the patient sits up.
It is well known that the great majority of patients with tuberculous and epidemic cerebrospinal meningitis have the classical rather intense stiffness of the neck and back (although a few patients with acute meningitis have no muscle spasm at all, particularly with purulent secondary meningitis). As long as the patient is lying, there exists, in some of the cases, spasm of the extremities. In other cases—and these appear, in our observations up to now, to constitute the great majority—we find the recumbent patient to have stiffness of neck and back but no spasm in the extremities.
Kernig W. Concerning a Little Noted Sign of Meningitis. Arch Neurol. 1969;21(2):216–217. doi:10.1001/archneur.1969.00480140116013
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