Neck stiffness is the most important sign of meningitis. When the neck is flexed, the inflamed nerve roots and meninges of the cervical region get stretched. This causes protective muscle spasm manifesting as neck stiffness. Kernig's sign represents similar phenomena involving the distal spinal cord and related nerves. A manoeuvre that stretches the neural elements of the whole length of the spinal canal simultaneously will be a more sensitive test for meningeal irritation. Eliciting neck stiffness while the patient sits up with knees extended achieves this. This method is more sensitive, specific, and amenable to objective assessment.
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