Which of the following is a sign of meningeal irritation?

• A. Nuchal rigidity
• B. Nausea and vomiting
• C. Anxiousness
• D. Heightened sense of environment

Answer: (A)

Neck stiffness, or nuchal rigidity, is a hallmark of meningeal irritation. When the meninges are inflamed, moving the neck forward aggravates the pain, so a person resists or cannot flex the neck easily. This finding is classically seen in meningitis and related conditions affecting the meninges. In children, you’ll also look for other signs like photophobia and headache, though neck stiffness may be harder to assess in younger kids. Nausea and vomiting can occur with meningitis but are not specific to meningeal irritation. Anxiousness is nonspecific, and a heightened sense of environment isn’t a typical sign of meningeal irritation. In infants, signs shift to irritability, poor feeding, or a bulging fontanelle.