A hyperextended neck with pain on flexion suggests which condition?

• A. Meningeal irritation
• B. Muscle strain
• C. Osteoarthritis
• D. Torticollis

Answer: (A)

The key idea is recognizing signs of meningeal irritation. When the meninges are inflamed, the neck becomes stiff and painful to move, especially with flexion. If a child holds the neck in a more extended position to avoid bending it and experiences sharp pain when any attempt is made to flex the neck, this points to nuchal rigidity from meningeal irritation. This pattern is a strong indicator of meningitis or other meningeal inflammation and requires urgent evaluation.

Muscle strain tends to produce localized, activity‑related neck pain and tenderness without the classic stiff neck that resists flexion. Osteoarthritis is a degenerative, usually chronic condition with gradual stiffness and is less likely to present as an acute, painful resistance to neck flexion in a child. Torticollis causes a noticeable abnormal head position (tilt or rotation) due to a contracted neck muscle, with pain and limited movement, but not the specific sign of painful resistance to neck flexion from meningeal irritation.