Neck stiffness

Nuchal rigidity Severe neck stiffness usually associated with meningitis inability to touch chin to chest. 

Signs and Symptoms Sudden onset of fever, headache, vomiting and possibly abdominal pain, progressing to neck stiffness, mental confusion, motor disturbances, and difficulty with equilibrium. Survivors may suffer significant impairment of mental functions. 

Signs and Symptoms Sudden onset of high-grade fever, sore throat, chills, headaches, neck stiffness, muscle pain (myalgia), and sensitivity to light (photophobia). Lesions appear in the throat and mouth, and on the palms and soles of the feet. Lymph nodes near the site of the bite may be enlarged. 

In the non-AIDS patient, the symptoms of cryptococcal meningitis are nonspecific. Headache, fever, nausea, vomiting, mental status changes, and neck stiffness are generally observed. In AIDS patients, fever and headache are common, but meningismus and photophobia are much less common than in non-AIDS patients. 

Headache accompanied by loss of consciousness, neck stiffness and neurological signs such as paraesthesia and slurred speech requires referral. 

Viral meningitis refers to inflammation of the meninges. It is characterised by headache, neck stiffness and may be accompanied by fever. Lumbar puncture is required to differentiate between bacterial meningitis and viral meningitis. 

Hypertensive crisis, marked by severe hypertension, occipital headache radiating frontally, neck stiffness or soreness, nausea, vomiting, sweating, fever or chilliness, clammy skin, dilated pupils, palpitations, tachycardia or bradycardia, and constricting chest pain. 

Monitor the patient for occipital headache radiating frontally and neck stiffness or soreness, which may be the first sign of impending hypertensive crisis... 

Hypertensive crises are characterized initially by headache, but can evolve to include neck stiffness, chest discomfort, palpitations, confusion, and, ultimately, hemorrhage or stroke. Treatment of MAOI-associated hypertension may include a watch-and-wait stance by the patient if the symptoms are mild. Some patients have the ability to check and monitor their own blood pressure. Others may consult with a physician for blood pressure checks and observation, but if symptoms are severe, the patient may need to go to an emergency room or self-medicate. Standard emergency room treatment is intravenous phentolamine, an a-adrenergic blocker, continuous monitoring and management until blood pressure is normalized without medication. Some doctors will provide patients with small doses of chlorpromazine or nifedipine to treat hypertension if a problem arises. 

A 44-year-old man took amfebutamone 300 mg/day and buspirone 45 mg/day for depression (9). Over 2-3 weeks he developed increasing neck stiffness, with tightening and spasm of the jaw muscles and pain in the left temporomandibular joint. He stopped taking his medications, and all his symptoms resolved over the next 3 weeks. Rechallenge with buspirone (45 mg/day) failed to reproduce the dystonic symptoms. The buspirone was withdrawn and amfebutamone 150 mg/day was started the dystonic symptoms did not recur. However, 24 hours after the dose of amfebutamone was increased to 300 mg/day there was a return of neck stiffness and jaw spasm. 

Most patients treated for neurocysticercosis with praziquantel develop an early cerebrospinal fluid reaction a similar late reaction, some 2 weeks after treatment has finished, has also been described (16). In both cases clinical signs and sjmptoms can include papilledema, headache, nausea, vomiting, neck stiffness, and even focal seizures. Glucocorticoids can usually prevent or relieve both the early and late reactions, but they can also reduce efficacy by lowering plasma concentrations of the drug by some 50% (17). 

Adverse reactions following therapeutic use include sedation, dizziness, insomnia, agitation, tardive dyskinesia, dysphoria, dystonic reactions, tachycardia, syncope, anorexia, nausea, vomiting, constipation, diarrhea, and dyspepsia. The most frequently reported dystonic reactions include akathisia, stiff neck, stiff or protruding tongue, and tremor. 

In meningitis there may be a severe generalised headache associated with fever, nausea, neck stiffness, pain behind knees when extended (Kernig s sign) and a purpuric rash in later stages. Refer urgently any child with headache, high temperature and who is unable to bend head forward easily. 

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