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ULY CLINIC

24 Septemba 2025, 14:15:15

Guilland’s sign

Guilland’s sign refers to a quick, energetic flexion of the hip and knee on one side in response to pinching the contralateral quadriceps muscle. It is a clinical indicator of meningeal irritation, commonly seen in conditions such as meningitis, subarachnoid hemorrhage, or other causes of meningeal inflammation.

Pathophysiology

Meningeal irritation increases excitability of spinal reflex pathways.
Pinching the quadriceps stimulates afferent sensory fibers, which trigger a crossed reflex response via spinal interneurons, resulting in contralateral hip and knee flexion.
This is similar to other signs of meningeal irritation (e.g., Brudzinski’s and Kernig’s signs) and reflects increased sensitivity of the lumbar spinal cord segments.

Examination Technique

Patient positioning: Place the patient supine on an examination table with legs extended.
Instruction: Explain that the test may be slightly uncomfortable.
Stimulation: Pinch the quadriceps muscle of one leg firmly but safely.
Observation: Watch for energetic flexion of the contralateral hip and knee.
Assessment: A positive Guilland’s sign is the crossed flexion response, indicating meningeal irritation.
Documentation: Record side of stimulation, side of response, and intensity of flexion.

Clinical Features

Feature	Manifestation
Contralateral hip/knee flexion	Quick, energetic response to quadriceps pinch
Associated signs	May coexist with Brudzinski’s sign, Kernig’s sign, neck stiffness
Symptoms	Headache, fever, photophobia, nausea, vomiting
Systemic correlation	Signs of meningitis or meningeal inflammation

Differential Diagnosis

Condition	Key Feature	Notes
Acute bacterial meningitis	Positive Guilland’s + fever, headache, neck stiffness	Requires urgent evaluation and treatment
Viral meningitis	May also show meningeal signs but less severe	Usually self-limiting
Subarachnoid hemorrhage	Sudden severe headache + meningeal irritation	Often accompanied by neurologic deficits
Irritable or tense muscles	Localized muscular response, no systemic signs	Usually unilateral and not contralateral

Pediatric considerations

May be difficult to elicit in uncooperative infants and children.
Other meningeal signs may be preferred (e.g., neck stiffness, Brudzinski’s sign).

Geriatric considerations

Older adults may have subtle meningeal signs.
Guilland’s sign may be less pronounced; always interpret with other clinical findings and history.

Limitations

Requires patient cooperation and adequate relaxation.
False negatives may occur in very weak or obtunded patients.
Should not be performed aggressively to avoid pain or injury.

Patient counseling

Explain that the reflex is a diagnostic maneuver for meningeal irritation, not a sign of primary leg injury.
Reassure the patient that the test is safe when performed gently.
Advise immediate evaluation if positive, as meningeal irritation may indicate a serious underlying condition.

Conclusion

Guilland’s sign is a clinical indicator of meningeal irritation, elicited via a contralateral quadriceps pinch. Its detection aids in the early recognition of meningitis or other meningeal pathologies, guiding timely diagnosis and intervention.

References

Berman, P. Meningeal signs and their clinical significance. Neurol Clin. 2012;30(2):447–460.
Tunkel AR, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267–1284.
Adams RD, Victor M. Principles of Neurology. 11th ed. New York: McGraw-Hill; 2021.
Carroll WM. Meningeal irritation: clinical evaluation and signs. J Neurol Neurosurg Psychiatry. 2013;84:659–664.