Examination of the skull and spine is important and the physician should always look for neck stiffness. Kernig's test in which the resistance to flexion of the thigh with the leg extended is examined, or Brudzinski's test in which the flexion of one thigh is noted to cause flexion of the other, should be performed to help in differentiating neck stiffness due to meningeal irritation from that due to a developing tonsillar pressure cone. Positive Kernig's and Brudzinski's tests together with neck stiffness imply inflammation in the lumbar theca and suggest a diffuse meningitic process. If these tests are negative, however, then the neck stiffness alone is more suggestive of a foraminal pressure cone.15
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