Physical examination maneuver
Physical Exam
Nuchal Rigidity
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With the patient supine, support the head and gently flex the neck, bringing the chin toward the chest. Nuchal rigidity is present when there is involuntary resistance to passive neck flexion, while side-to-side rotation remains relatively preserved.
How to Interpret
Showing all 3 findings
Meningitis
Neck stiffness
Rule in
Minimally helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Moderate
Stroke
Neck stiffness
Rule in
Helpful
Rule out
Not helpful
Evidence:StrongResearch in progress
Subarachnoid Hemorrhage
Neck stiffness (sudden headache presentation)
Rule in
Helpful
Rule out
Not helpful
Evidence:Strong
Related Bedside Tests
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Brudzinski Sign
aka Nape-of-the-neck sign
Rule in:SHMeningitis
Rule out:NHMeningitis
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Kernig Sign
Rule in:SHMeningitis, ICStroke
Rule out:NHMeningitis, NHStroke
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Ophthalmoscopy
aka Fundoscopy
Rule in:VHGlaucoma, VHIncreased Intracranial Pressure, SHDiabetic Retinopathy +14 more
Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +14 more
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Pronator Drift
Rule in:VHBrain Tumor, VHFunctional Neurologic Disease, HUpper Motor Neuron Lesion +5 more
Rule out:VHFunctional Neurologic Disease, VHUpper Motor Neuron Lesion, MHBrain Tumor +5 more
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Pupillary Light Reaction
Rule in:VHSerious Eye Disease, HPoor Neurologic Outcome, HStructural Brain Lesion +11 more
Rule out:SHPoor Neurologic Outcome, SHSerious Eye Disease, SHStructural Brain Lesion +11 more
🎬Video coming soon
Blood Pressure
Rule in:VHHypovolemia, VHMortality, VHStructural Brain Lesion +22 more
Rule out:VHCardiac Tamponade, VHHypovolemia, HLow Cardiac Output +22 more