OnExam

This test is used to detect meningeal inflammation from infection or subarachnoid hemorrhage. Use in the presence of clinical features that suggest meningitis (i.e., fever, headache, neck stiffness, photophobia, nausea, vomiting).

Performing the Test

  1. Ensure there is no injury to the cervical vertebrae or spinal cord
  2. Position the patient supine
  3. Place hands behind patient’s head and flex neck forward (chin to chest if possible)
  4. If the patient’s neck is stiff with resistance, the sign is positive.
  5. If the patient’s neck is easily moved with little resistance, the sign is negative
Children
  • Specificity: 89%
  • Sensitivity: 51%
Adults
  • Specificity: 68%
  • Sensitivity: 30%

References

  1. Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins: 2003.
  2. Lincoln, Matthew, McSheffrey eds. Essentials of Clinical Examination Handbook. 6th ed. Toronto, ON: University of Toronto Medical Society: 2010.