Physical examination maneuver

Physical Exam

Kernig Sign

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Video coming September 2026

How to Perform

With the patient supine, flex one hip and knee to 90°. Maintain the hip in flexion and slowly extend the knee. A positive sign is marked resistance or pain that limits knee extension, classically preventing the knee from extending beyond about 135°.

How to Interpret

Showing all 2 findings

Meningitis

Kernig sign positive
Rule in
Not helpfulWide CI
Rule out
Not helpfulDerived CI
Evidence:Limited

Stroke

Kernig or Brudzinski sign
Rule in
InconclusiveWide CI
Rule out
Not helpful
Evidence:Limited

References

  • 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. Clin Infect Dis. 2002;35(1):46-52. doi:10.1086/340979. PubMed: 12060874
  • Runchey S, McGee S. Does this patient have a hemorrhagic stroke? Clinical findings distinguishing hemorrhagic stroke from ischemic stroke. JAMA. 2010;303(22):2280-2286. doi:10.1001/jama.2010.754. PMID: 20530782.
  • Kernig VM. Über ein Krankheitssymptom der acuten Meningitis. St Petersb Med Wochenschr. 1882;7:398.

Research last updated September 9, 2026.

Related Diagnoses

MeningitisStroke

Related Systems / Regions

Lower ExtremitiesNeurological

Related Bedside Tests

🎬Video coming Sept 2026
Nuchal Rigidity
Rule in:HStroke, NHMeningitis, IESubarachnoid Hemorrhage
Rule out:NHMeningitis, NHStroke, IESubarachnoid Hemorrhage
🎬Video coming Sept 2026
Brudzinski Sign
aka Nape-of-the-neck sign
Rule in:NHMeningitis
Rule out:NHMeningitis
🎬Video coming Sept 2026
Pronator Drift
Rule in:VHBrain Tumor, VHFunctional Neurologic Disease, HStroke +5 more
Rule out:VHFunctional Neurologic Disease, VHStroke, MHBrain Tumor +5 more
🎬Video coming Sept 2026
Pupillary Light Reaction
Rule in:VHSerious Eye Disease, HPoor Neurologic Outcome, HStructural Brain Lesion +11 more
Rule out:SHSerious Eye Disease, MHPoor Neurologic Outcome, MHStructural Brain Lesion +11 more
🎬Video coming Sept 2026
Blood Pressure
Rule in:VHHypovolemia, VHMortality, VHStructural Brain Lesion +22 more
Rule out:VHCardiac Tamponade, VHHypovolemia, HLow Cardiac Output +22 more
🎬Video coming Sept 2026
Babinski Reflex
aka Plantar reflex
Rule in:VHUpper Motor Neuron Lesion, VHVascular Parkinsonism, IEMotor Neuron Disease +4 more
Rule out:SHUpper Motor Neuron Lesion, NHVascular Parkinsonism, IEMotor Neuron Disease +4 more