II. Causes

  1. Intracranial causes
    1. Intracranial Mass (esp. Posterior fossa tumor)
    2. Subarachnoid Hemorrhage
    3. Meningitis
    4. Meningismus
    5. Increased Intracranial Pressure
  2. Extracranial Causes
    1. Retropharyngeal or cervical Lymphadenitis (especially young children)
    2. Retropharyngeal Abscess or Cellulitis
    3. Sinusitis
    4. Mastoiditis
    5. Torticollis
    6. Dystonic Reaction
    7. Cervical SpineOsteomyelitis
    8. Upper lobe Pneumonia

III. Efficacy: Meningeal signs

  1. Do not rely on these signs due to low efficacy
  2. Kernig's Sign and Brudzinski's Sign
    1. Test Sensitivity: 5%
    2. Test Specificity: 95%
  3. Nuchal Rigidity
    1. Test Sensitivity: 30%
    2. Test Specificity: 68%
  4. References
    1. Thomas (2002) Clin Infect Dis 35:46-52 [PubMed]

IV. Exam: Nuchal Rigidity

  1. Involuntary muscle spasm limits passive neck flexion
  2. Patient cannot flex neck to place chin on chest
  3. Unreliable in age under 18 months due to underdeveloped neck musculature

V. Exam: Spinal Rigidity

  1. Erector spinae muscle spasm limits spine movement
  2. Opisthotonos (rigid arched back) may occur

VI. Exam: Kernig's Signs

  1. Technique
    1. Patient supine
    2. Flex both hip and knee to 90 degrees
    3. Hold hip immobile and extend knee
  2. Positive Test suggesting Meningeal Irritation
    1. Resistance to knee extension
    2. Pain in hamstrings

VII. Exam: Brudzinski's Sign

  1. Technique
    1. Patient supine
    2. Immobilize trunk against bed
    3. Flex neck, chin to chest
  2. Positive Test suggesting Meningeal Irritation
    1. Involuntary hip flexion

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Ontology: Nuchal Rigidity (C1320474)

Concepts Sign or Symptom (T184)
MSH D009127
SnomedCT 4697007, 405947006
English Nuchal Rigidity, Rigidity, Nuchal, nuchal rigidity, Nuchal rigidity, Nuchal rigidity (finding)
Japanese 項部硬直, コウブコウチョク
Portuguese Rigidez da Nuca, Rigidez da nuca
Spanish Rigidez de la Nuca, Rigidez de nuca, rigidez de nuca (hallazgo), rigidez de nuca
French Raideur de la nuque, Rigidité de la nuque
German Nuchale Rigidität, Nackenrigiditaet, Rigidität im Nackenbereich
Czech Rigidita šíje, nuchální rigidita
Hungarian Nyakmerevedés
Norwegian Nakkestivhet
Italian Rigidità nucale
Dutch nekstijfheid, Nekrigiditeit