Which clinical finding is most indicative of meningitis?

• A. Cough
• B. Nuchal rigidity
• C. Abdominal pain
• D. Headache alone

Answer: (B)

Neck stiffness is the best indicator because it directly signals irritation of the meninges surrounding the brain and spinal cord. In meningitis, the inflamed meninges make neck flexion uncomfortable and difficult, a sign known as nuchal rigidity. This finding is more specific to meningeal irritation than a headache alone, which is a common symptom in many conditions, or unrelated symptoms like cough or abdominal pain. While headache can occur with meningitis, it’s not as specific. In practice, clinicians also check for other meningeal signs (like Kernig or Brudzinski) and assess fever and mental status to support the diagnosis, but neck stiffness remains the most distinguishing single sign among the options.