College of Nursing Education rd 3 Floor, DPT Building Matina Campus, Davao City Telefax: (082) Phone No.

: (082)300-5456/300-0647 Local 141

In Partial Fulfillment for Requirement in CA 100 Concept: Coordination and Perception __________ Presented to the Faculty of the University of Mindanao College of Nursing Education __________ Submitted to: Kristel Ramos, RN, USRN _________

Submitted by: Altamirano, Althea C. Andan, Jehan Kartini H. Carmen, Deborah R. Ismael, Kish Micah P. Roldan, Bobby Lorenz P. Suam, Anna Ruby Q. Tero, Romeo Aroll Dave A.

Date of Submission July 2011

HYDROCEPHALUS I. Definition

Hydrocephalus is a condition caused by an imbalance in the production and absorption of CSF in the ventricular system. When production exceeds absorption, CSF accumulates, usually under pressure, producing dilation of the ventricles. It is a term derived from the Greek words hydro meaning water, and cephalus meaning head and this condition is sometimes known as water on the brain. People with hydrocephalus have abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head, convulsion, and mental disability. II. Etiology

The causes of hydrocephalus are still not well understood. Hydrocephalus may result from inherited genetic abnormalities (such as the genetic defect that causes aqueductal stenosis) or developmental disorders (such as those associated with neural tube defects including spina bifida and encephalocele). Other possible causes include complications of premature birth such as intraventricular hemorrhage, diseases such as meningitis, tumors, traumatic head injury, or subarachnoid hemorrhage, which block the exit of CSF from the ventricles to the cisterns or eliminate the passageway for CSF into the cisterns. Classification of Hydrocephalus: Based on its underlying mechanisms, hydrocephalus can be classified into communicating and non-communicating (obstructive). Both forms can be either congenital, or acquired. 1. Communicating Also known as non-obstructive hydrocephalus It is caused by impaired cerebrospinal fluid resorption in the absence of any CSF-flow obstruction. It has been theorized that this is due to functional impairment of the arachnoid granulations, which are located along the superior sagittal sinus and is the site of cerebrospinal fluid resorption back into the venous system. Various neurologic conditions may result in communicating hydrocephalus, including subarachnoid/intraventricular hemorrhage, meningitis, Chiari malformation, and congenital absence of arachnoidal granulations (Pacchionis granulations). Normal pressure hydrocephalus (NPH) is a particular form of communicating hydrocephalus, characterized by enlarged cerebral ventricles, with only intermittently elevated cerebrospinal fluid pressure. The diagnosis of NPH can be established only with the

help of continuous intraventricular pressure recordings (over 24 hours or even longer), since more often than not, instant measurements yield normal pressure values. Dynamic compliance studies may be also helpful. Altered compliance (elasticity) of the ventricular walls, as well as increased viscosity of the cerebrospinal fluid, may play a role in the pathogenesis of normal pressure hydrocephalus. Hydrocephalus ex vacuo also refers to an enlargement of cerebral ventricles and subarachnoid spaces, and is usually due to brain atrophy (as it occurs in dementias), posttraumatic brain injuries and even in some psychiatric disorders, such as schizophrenia. As opposed to hydrocephalus, this is a compensatory enlargement of the CSF-spaces in response to brain parenchyma loss it is not the result of increased CSF pressure. 2. Non-communicating Non-communicating hydrocephalus, or obstructive hydrocephalus, is caused by a CSFflow obstruction (either due to external compression or intraventricular mass lesions). Foramen of Monro obstruction may lead to dilation of one or, if large enough (e.g., in colloid cyst), both lateral ventricles. The aqueduct of Sylvius, normally narrow to begin with, may be obstructed by a number of genetically or acquired lesions (e.g., atresia, ependymitis, hemorrhage, tumor) and lead to dilatation of both lateral ventricles as well as the third ventricle. Fourth ventricle obstruction will lead to dilatation of the aqueduct as well as the lateral and third ventricles. The foramina of Luschka and foramen of Magendie may be obstructed due to congenital failure of opening (e.g., Dandy-Walker malformation). The subarachnoid space surrounding the brainstem may also be obstructed due to inflammatory or hemorrhagic fibrosing meningitis, leading to widespread dilatation, including the fourth ventricle. Congenital

The cranial bones fuse by the end of the third year of life. For head enlargement to occur, hydrocephalus must occur before then. The causes are usually genetic but can also be acquired and usually occur within the first few months of life, which include 1) intraventricular matrix hemorrhages in premature infants, 2) infections, 3) type II Arnold-Chiari malformation, 4) aqueduct atresia and stenosis, and 5) Dandy-Walker malformation. In newborns and toddlers with hydrocephalus, the head circumference is enlarged rapidly and soon surpasses the 97th percentile. Since the skull bones have not yet firmly joined together, bulging, firm anterior and posterior fontanelles may be present even when the patient is in an upright position. The infant exhibits fretfulness, poor feeding, and frequent vomiting. As the hydrocephalus progresses, torpor sets in, and the infant shows lack of interest in his surroundings. Later on, the upper eyelids become retracted and the eyes are turned downwards (due to hydrocephalic pressure on the mesencephalic tegmentum and

paralysis of upward gaze). Movements become weak and the arms may become tremulous. Papilledema is absent but there may be reduction of vision. The head becomes so enlarged that the child may eventually be bedridden. About 80-90% of fetuses or newborn infants with spina bifidaoften associated with meningocele or myelomeningoceledevelop hydrocephalus. Acquired

This condition is acquired as a consequence of CNS infections, meningitis, brain tumors, head trauma, intracranial hemorrhage (subarachnoid or intraparenchymal) and is usually extremely painful. III. Pathophysiology

The fluid surrounding the brain (cerebrospinal fluid, CSF) is produced in spaces within the brain called ventricles. The fluid must be drain to a different area, where it is absorbed into the blood. When the fluid cannot drain, hydrocephalus (water in the brain) develops. Hydrocephalus often increases the pressure in the ventricles, which compresses the brain. Many conditions, such as a birth defect, bleeding within the brain, or brain tumors can block drainage and cause hydrocephalus. An abnormally large head may be a symptom of hydrocephalus. The infant usually fails to develop normally. CT scan, ultrasound, or MRI scan of the head reveals the diagnosis as well as the degree of brain compression. The goal of treatment is to keep pressure normal within the brain. A permanent alternate drainage path (shunt) for CSF decreases the pressure and volume of the fluid inside the brain. A doctor places the shunt in the ventricles in the brain and runs it under the skin from the head to another site, usually the abdomen (ventriculoperitoneal shunt). The shunt contains a valve that allows fluid to leave the brain if the pressure becomes too high. Although a few children can eventually do without the shunt as they get older, shunts are rarely removed. If needed, pressure within the brain can often be temporarily reduced with drugs (such as acetazolamide or furosemide) or repeated lumbar puncture until a shunt is placed. Some children with hydrocephalus develop normal intelligence. Others are mentally retarded or have learning disabilities.

IV.

Symptomatology

Symptoms of hydrocephalus vary with age, disease progression, and individual differences in tolerance to the condition. For example, an infant's ability to compensate for increased CSF pressure and enlargement of the ventricles differs from an adult's. The infant skull can expand to accommodate the buildup of CSF because the sutures (the fibrous joints that connect the bones of the skull) have not yet closed. In infancy, the most obvious indication of hydrocephalus is often a rapid increase in head circumference or an unusually large head size. Other symptoms may include vomiting,

sleepiness, irritability, downward deviation of the eyes (also called "sunsetting"), and seizures. Older children and adults may experience different symptoms because their skulls cannot expand to accommodate the buildup of CSF. Symptoms may include headache followed by vomiting, nausea, papilledema (swelling of the optic disk which is part of the optic nerve), blurred or double vision, sunsetting of the eyes, problems with balance, poor coordination, gait disturbance, urinary incontinence, slowing or loss of developmental progress, lethargy, drowsiness, irritability, or other changes in personality or cognition including memory loss. SYMPTOMATOLOGY Abnormal rate of head growth Bulging fontanelle Tense anterior fontanelle (often bulging and nonpulsatile) Dilated scalp veins Macewens sign (cracked pot) Frontal bossing Setting sun sign Sluggish and unequal pupils Irritability and lethargy with varying LOC Abnormal infantile reflexes Possible cranial nerve damage

V.

Diagnostic Exams/Test

Hydrocephalus is diagnosed through clinical neurological evaluation and by using cranial imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), or pressure-monitoring techniques. A physician selects the appropriate diagnostic tool based on an individual's age, clinical presentation, and the presence of known or suspected abnormalities of the brain or spinal cord. VI. Medical Management

Hydrocephalus is most often treated by surgically inserting a shunt system. This system diverts the flow of CSF from the CNS to another area of the body where it can be absorbed as part of the normal circulatory process. A shunt is a flexible but sturdy plastic tube. A shunt system consists of the shunt, a catheter, and a valve. One end of the catheter is placed within a ventricle inside the brain or in the CSF outside the spinal cord. The other end of the catheter is commonly placed within the abdominal cavity, but may also be placed at other sites in the body such as a chamber of the heart or areas around the lung where the CSF can drain and be absorbed. A valve located along the catheter maintains one-way flow and regulates the rate of CSF flow. A limited number of individuals can be treated with an alternative procedure called third ventriculostomy. In this procedure, a neuroendoscope a small camera that uses fiber optic technology to visualize small and difficult to reach surgical areas allows a doctor to view the ventricular surface. Once the scope is guided into position, a small tool makes a tiny hole

in the floor of the third ventricle, which allows the CSF to bypass the obstruction and flow toward the site of resorption around the surface of the brain. VII. Nursing Management

1. Teach the family about the management required for the disorder a. Treatment is surgical by direct removal of an obstruction and insertion of shunt to provide primary drainage of the CSF to an extracranial compartment, usually peritoneum (ventriculoperitoneal shunt) 1. The major complications of shunts are infections and malfunction 2. Other complications include subdural hematoma caused by a too rapid reduction of CSF, peritonitis, abdominal abscess, perforation of organs, fistulas, hernias and ileus. b. A third ventriculostomy is a new nonshunting procedure used to treat children with hydrocephalus. 2. Provide preoperative nursing care a. Assess head circumference, fontanelles, cranial sutures, and LOC; check also for irritability, altered feeding habits and a high-pitched cry. b. Firmly support the head and neck when holding the child. c. Provide skin care for the head to prevent breakdown. d. Give small, frequent feedings to decrease the risk of vomiting. e. Encourage parental-newborn bonding. 3. Provide Postoperative nursing care (nursing interventions are the same as those for increased ICP) a. Assess for signs of increased ICP and check the following; head circumference (daily), anterior fontanelle for size and fullness and behavior. b. Administer prescribed medications which may include antibiotics to prevent infection and analgesics for pain. c. Provide shunt care 1. Monitor for shunt infection and malfunction which may be characterized by rapid onset of vomiting, severe headache, irritability, lethargy, fever, redness along the shunt tract, and fluid around the shunt valve. 2. Prevent infection (usually Staphylococcus aureus) from Staphylococcus epidermis or

3. Monitor for shunt overdrainage (headache, dizziness and nausea). Overdrainage may lead to slit ventricle syndrome whereby the ventricle become accustomed to a very small or slitlike configuration, limiting the buffering ability to increased ICP variations. 4. Teach home care a. Encourage the child to participate in age-appropriate activities as tolerated. Encourage the parents to provide as normal lifestyle as possible. Remind both the child and parents that contact sports are prohibited. b. Explain how to recognize signs and symptoms of increased ICP. Subtle signs include changes in school performance, intermittent headache, and mild behavior changes. c. Arrange for the child to have frequent developmental screenings and routine medical checkups. VIII. Questions with Rationale 1. A baby has just been delivered, and you are examining its posture. The baby has tremors, twitches, startles easily, arms and hands are flexed,legs extended. What is this called? a) hypotonia b) hypertonia c) opisthotonic posturing d) expected Answer: b) hypertonia: baby has tremors, twitches, startles easily, arms and hands are flexed,legs extended 2. A preterm baby has been delivered. You are inspecting her posture. Which of the following would be expected? a) slight flexion of extremities; holds head erect momentarily, turns head from side to side when prone; may have brief tremors b) limp extended limbs, legs abducted c) limp extended extremities, marked head lag d) tremors, twitches, startles easily, arms and hands are flexed, legs extended Answer: b) expected preterm baby posture: limp extended limbs, legs abducted

3. A baby has been delivered. You are inspecting her posture and find that she has hypotonia. Which of the following would be matches the description of hypotonia? a) slight flexion of extremities; holds head erect momentarily, turns head from side to side when prone; may have brief tremors b) limp extended limbs, legs abducted c) limp extended extremities, marked head lag d) tremors, twitches, startles easily, arms and hands are flexed,legs extended Answer: c) hypotonia: limp extended extremities, marked head lag 4. You are examining the head shape of a newborn. The doctor mentioned he has caput succedaneum. Which of the following should you observe in the baby? a) Diffuse edema of soft scalp tissue that crosses suture line b)Hematoma between periosteum and skull bone; unilateral and does not cross suture line c) Muscle twitching, seizures, cyanosis, breathing abnormal, shrill cry d) Head large compared to chest; small fontanels; hair like matted wool Answer: a) caput succedaneum: Diffuse edema of soft scalp tissue that crosses suture line 5. You are examining the head shape of a newborn. There is a family history of cephalhematoma. Which of the following matches the description of cephalhematoma? a) Diffuse edema of soft scalp tissue that crosses suture line b) Hematoma between periosteum and skull bone; unilateral and does not cross suture line c) Muscle twitching, seizures, cyanosis, breathing abnormal, shrill cry d) Head large compared to chest; small fontanels; hair like matted wool Answer: b) cephalhematoma : Hematoma between periosteum and skull bone; unilateral and does not cross suture line 6. You are examining the head shape of a newborn. Looking at the signs, you fear there may be intracranial hemmorhage. Which of the following are indications of intracranial hemorrhage? a) Diffuse edema of soft scalp tissue that crosses suture line

b) Hematoma between periosteum and skull bone; unilateral and does not cross suture line c) Muscle twitching, seizures, cyanosis, breathing abnormal, shrill cry d) Head large compared to chest; small fontanels; hair like matted wool Answer: c) indications of intracranial hemorrhage: Muscle twitching, seizures, cyanosis, breathing abnormal, shrill cry 7. You are completing measurements of a newborn and after noted that she may have hydrocephalus. Which of the following may indicate hydrocephalus? a) bulging or depressed fontanels when quiet b) widened sutures or fontanels c) head circumference < 10th percentile d) head circumference > 90th percentile Answer: d) hydrocephalus: head circumference > 90th percentile 8. You are completing measurements of a newborn and after noted that she may have microcephaly. Which of the following may indicate microcephaly? a) bulging or depressed fontanels when quiet b) widened sutures or fontanels c) head circumference < 10th percentile d) head circumference > 90th percentile Answer: c) microcephaly: head circumference < 10th percentile 9. A preterm baby has just been delivered. What would you expect its head shape to be like? a) Diffuse edema of soft scalp tissue that crosses suture line b) Widened sutures or fontanels c) Muscle twitching, seizures, cyanosis, breathing abnormal, shrill cry d) Head large compared to chest; small fontanels; hair like matted wool Answer: d) expected characteristics of preterm baby: Head large compared to chest; small fontanels; hair like matted wool

10. You are examining a newborn's eyes. You notice he has epicanthal folds. When would this be expected? a) If he is of African descent b) If he is of European descent c) If he is of Native American descent d) If he is of Asian descent Answer: d) Epicanthal folds are expected if he is of Asian descent

Meningitis Meningitis is inflammation of the coverings around the brain and spinal cord. It is usually caused by an infection. The infection occurs most often in children, teens, and young adults. Also at risk are older adults and people who have long-term health problems, such as a weakened immune system. There are two main kinds of meningitis:

Viral meningitis is fairly common. It usually does not cause serious illness. In severe cases, it can cause prolonged fever and seizures. Bacterial meningitis is not as common but is very serious. It needs to be treated right away to prevent brain damage and death.

The two kinds of meningitis share the same symptoms. It's very important to see a doctor if you have symptoms, so that he or she can find out which type you have. Causes Viral meningitis is caused by viruses. Bacterial meningitis is caused by bacteria. Meningitis can also be caused by other organisms and some medicines, but this is rare. Meningitis is contagious. The germs that cause it can be passed from one person to another through coughing and sneezing and through close contact. Pathophysiology

Signs and symptoms The most common symptoms among teens and young adults are:

A stiff and painful neck, especially when you try to touch your chin to your chest. Fever. Headache. Vomiting. Trouble staying awake. Seizures.

Children, older adults, and people with other medical problems may have different symptoms:

Babies may be cranky and refuse to eat. They may have a rash. They may cry when held. Young children may act like they have the flu. They may cough or have trouble breathing. Older adults and people with other medical problems may have only a slight headache and fever.

It is very important to see a doctor right away if you or your child has these symptoms. Only a doctor can tell whether they are caused by viral or bacterial meningitis. And bacterial meningitis can be deadly if not treated right away. Diagnostic exam and treatment Lumbar puncture is the most important lab test for meningitis. It is also called a spinal tap. A sample of fluid is removed from the spine and tested to see if it contains organisms that cause the illness. Complete blood count (CBC), to check for signs of infection Blood culture, to check for infections Urine test, to check for infection in the urinary tract Chest X-ray, to check for lung infections Biopsy of a skin rash Computed tomography (CT scan) or magnetic resonance image (MRI), to look for swelling of brain tissue or for complications such as brain damage.

Bacterial or severe viral meningitis may require treatment in a hospital, including: Antibiotics. These medicines usually are given through a vein (intravenously, or IV) to treat meningitis. Antibiotics are given only when bacteria are causing the infection. Giving antibiotics when they are not needed may cause drug resistance. Measures to reduce pressure within the brain. If meningitis is causing pressure within the brain, corticosteroid medicines such as dexamethasone may be given to adults or children.

 Measures to reduce fever. Medicines such as acetaminophen (Tylenol), fluids, and good room ventilation reduce fever. If you have a high fever, you also may need a device such as a cooling pad placed on the bed. Measures to prevent seizures. If you have seizures, your surroundings will be kept quiet and calm. Medicines such as phenobarbital or Dilantin can help stop seizures. For more information, see the topic Seizures. Oxygen therapy. Oxygen may be given if you have trouble breathing and to increase the amount of oxygen in all parts of the body. Oxygen may be delivered by a hood or tent placed over the body, a face mask placed over the nose and mouth, a nose piece (nasal cannula) held loosely under the nose, or, in severe cases, a tube through the mouth into the trachea (windpipe). Monitoring fluids. You may need to drink extra liquids because infections increase the body's need for fluids. Increasing liquids also reduces the possibility of dehydration. Liquids are given into a vein (IV) if you have an infection and are vomiting or are not able to drink enough. Doctors control the amount of fluids given because people with meningitis may develop problems if they have too much or not enough fluid. Monitoring blood chemicals. Frequent blood tests are done to measure essential body chemicals, such as sodium and sugar in the blood. Nursing Management (1) Administer intravenous fluids and medications, as ordered by the physician. (a) Antibiotics should be started immediately. (b) Corticostertoids may be used for the critically ill patient. (c) Drug therapy may be continued after the acute phase of the illness is over to prevent recurrence. (d) Record intake and output carefully and observe patient closely for signs of dehydration due to insensible fluid loss. (2) Monitor patient's vital signs and neurological status and record. (a) Level of consciousness. Utilize GCS for accuracy and consistency. (b) Monitor rectal temperature at least every 4 hours and, if elevated, provide for cooling measures such as a cooling mattress, cooling sponge baths, and administration of ordered antipyretics. (3) If isolation measures are required, inform family members and ensure staff compliance of isolation procedures in accordance with (IAW) standard operating procedures (SOP). (4) Provide basic patient care needs. (a) The patient's level of consciousness will dictate whether the patient requires only assistance with activities of daily living or total care. If patient is not fully conscious, follow the guidelines for care of the unconscious patient (Part 5).

(b) Maintain dim lighting in the patient's room to reduce photophobic discomfort. (5) Provide discharge planning information to the patient and family. (a) Follow up appointments with the physician. (b) Discharge medication instruction. (c) Possible follow-up with the community health nurse.

Question with Answer and Rationale 1. A patient asks a nurse, My doctor recommended I increase my intake of folic acid. What type of foods contain the highest concentration of folic acids? 1. Green vegetables and liver 2. Yellow vegetables and red meat 3. Carrots 4. Milk Rationale: 1. Green vegetables and liver are a great source of folic acid.

2. A nurse is putting together a presentation on meningitis. Which of the following microorganisms has noted been linked to meningitis in humans? 1. S. pneumonia 2. H. influenza 3. N. meningitis 4. Cl. difficile

Rationale: 4. Cl. difficile has not been linked to meningitis. 3. A patients chart indicates a history of meningitis. Which of the following would you not expect to see with this patient if this condition were acute? 1. Increased appetite 2.Vomiting 3. Fever 4. Poor tolerance of light Rationale: 1 Loss of appetite would be expected.

4. During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which of the following would be most appropriate to institute? 1. 2. 3. 4. Limiting conversation with the child Keeping extraneous noise to a minimum Allowing the child to play in the bathtub Performing treatments quickly

Rationale: 2. A child in the acute stage of meningitis is irritable and hypersensitive to loud noise and light. Therefore, extraneous noise should be minimized and bright lights avoided as much as possible. There is no need to limit conversations with the child. However, the nurse should speak in a calm, gentle, reassuring voice. The child needs gentle and calm bathing. Because of the acuteness of the infection, sponge baths would be more appropriate than tub baths. Although treatments need to be completed as quickly as possible to prevent overstressing the child, any treatments should be performed carefully and at a pace that avoids sudden movements to prevent startling the child and subsequently increasing intracranial pressure.

5. Which of the following would lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation? 1. 2. 3. 4. Hemorrhagic skin rash Edema Cyanosis Dyspnea on exertion Rationale: 1. DIC is characterized by skin petechiae and a purpuric skin rash caused by spontaneous bleeding into the tissues. An abnormal coagulation phenomenon causes the condition 6. When interviewing the parents of a 2-year-old child, a history of which of the following illnesses would lead the nurse to suspect pneumococcal meningitis? 1. 2. 3. 4. Bladder infection Middle ear infection Fractured clavicle Septic arthritis

Rationale: 2. Organisms that cause bacterial meningitis, such as pneumococci or meningococci, are commonly spread in the body by vascular dissemination from a middle ear infection. The meningitis may also be a direct extension from the paranasal and mastoid sinuses. The causative organism is a pneumonococcus. A chronically draining ear is frequently also found.

7. A lumbar puncture is performed on a child suspected of having bacterial meningitis. CSF is obtained for analysis. A nurse reviews the results of the CSF analysis and determines that which of the following results would verify the diagnosis? 1. 2. 3. 4. Cloudy CSF, decreased protein, and decreased glucose Cloudy CSF, elevated protein, and decreased glucose Clear CSF, elevated protein, and decreased glucose Clear CSF, decreased pressure, and elevated protein Rationale: 2. A diagnosis of meningitis is made by testing CSF obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include an elevated pressure, turbid or cloudy CSF, elevated leukocytes, elevated protein, and decreased glucose levels.

8. A nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which of the following would be included in the plan of care? 1. No precautions are required as long as antibiotics have been started 2. Maintain enteric precautions 3. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics 4. Maintain neutropenic precautions Rationale: 3. A major priority of nursing care for a child suspected of having meningitis is to administer the prescribed antibiotic as soon as it is ordered. The child is also placed on respiratory isolation for at least 24 hours while culture results are obtained and the antibiotic is having an effect.

9. A nurse is reviewing the record of a child with increased ICP and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse would expect to note which of the following if this type of posturing was present? 1. 2. 3. 4. Abnormal flexion of the upper extremities and extension of the lower extremities Rigid extension and pronation of the arms and legs Rigid pronation of all extremities Flaccid paralysis of all extremities

Rationale: 2. Decebrate posturing is characterized by the rigid extension and pronation of the arms and legs.

10. Which of the following assessment data indicated nuchal rigidity? 1. Positive Kernigs sign

2. Negative Brudzinskis sign 3. Positive homans sign 4. Negative Kernigs sign Rationale: 1. A positive Kernigs sign indicated nuchal rigidity, caused by an irritative lesion of the subarachnoid space. Brudzinskis sign is also indicative of the condition.