Which symptom is most characteristic of meningitis in older children?

• A. Stiff neck
• B. Earache
• C. Visual disturbance
• D. Cough

Answer: (A)

Meningeal irritation from meningitis shows up most clearly as neck stiffness in older children. When the meninges are inflamed, bending the neck forward becomes painful and difficult, a sign clinicians look for as a hallmark of meningitis. This stiffness is often accompanied by other symptoms like fever and headache, and may be reinforced by exam signs such as Brudzinski or Kernig, which reflect irritation of the meninges.

Earache isn’t typically a feature of meningitis itself and more often points to an ear infection. Visual disturbances can occur with meningitis but are less characteristic than neck stiffness in this age group. A cough is not a typical sign of meningitis and usually points to a respiratory issue.