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A violently ill patient with neck stiffness during the Texas meningitis epidemic of 1911 and 1912. Neck stiffness, stiff neck and nuchal rigidity are terms often used interchangeably to describe the medical condition when one experiences discomfort or pain when trying to turn, move, or flex the neck.
Meningism is a set of symptoms similar to those of meningitis but not caused by meningitis. [1] [3] [4] Whereas meningitis is inflammation of the meninges (membranes that cover the central nervous system), meningism is caused by nonmeningitic irritation of the meninges, usually associated with acute febrile illness, [1] [2] especially in children and adolescents. [2]
In technical anatomical/medical terminology, the nape is also called the nucha (from the Medieval Latin rendering of the Arabic نُخَاع, ' spinal marrow '). The corresponding adjective is nuchal, as in the term nuchal rigidity for neck stiffness.
Some of the possible symptoms of chronic meningitis (due to any cause) include headache, nausea and vomiting, fever, and visual impairment. Nuchal rigidity (or neck stiffness with discomfort in trying to move the neck), a classic symptom in acute meningitis, was seen in only 45% of cases of chronic meningitis with the sign being even more rare in non-infectious causes.
The patient with meningococcal meningitis typically presents with high fever, nuchal rigidity (stiff neck), Kernig's sign, severe headache, vomiting, purpura, photophobia, and sometimes chills, altered mental status, or seizures. Diarrhea or respiratory symptoms are less common.
Enteroviral meningitis (the most common cause) typically presents with the classic headache, photophobia, fever, nausea, vomiting, and nuchal rigidity. [15] With coxsackie and echo virus' specifically, a maculopapular rash may be present, or even the typical vesicles seen with Herpangina . [ 15 ]
Headache with nuchal rigidity (neck stiffness) may occur. One or both pupils may be dilated and sluggishly reactive. Infection can spread to contralateral cavernous sinus within 24–48 hours of initial presentation. [4]
The nuchal lines are four curved lines on the external surface of the occipital bone: The upper, often faintly marked, is named the highest nuchal line, but is sometimes referred to as the Mempin line or linea suprema, and it attaches to the epicranial aponeurosis. Below the highest nuchal line is the superior nuchal line.