• Chiazor U Onyia, Olusegun Akinniranye, Adebayo Olaitan, and Chimezie Agoha.
• Department of Surgery, Lagoon Hospitals Group, Lagos, Nigeria. Electronic address: shalomazor@yahoo.com.
• World Neurosurg. 2019 Jun 1; 126: 310-313.

BackgroundStiff neck or nuchal rigidity is a significant clinical sign of neurologic disease. It is commonly associated with meningitis, subarachnoid hemorrhage, and posterior fossa tumors. It may also occur as a result of tonsillar impaction following pressure in the infratentorial compartment from an expanding posterior fossa mass. It is, however, not commonly known to be associated with uncal herniation.Case DescriptionWe report a recent experience on this association.ConclusionsIn the presence of stiff neck or nuchal rigidity in a patient with clinical signs of uncal herniation from a temporal arachnoid cyst, this unusual association could possibly be owing to the effect of increased pressure in the posterior fossa from massive shift of brain tissue posteriorly following a rapid rise in middle cranial fossa pressure consequent on an acute enlargement of the cyst. A false impression of acute meningeal irritation in such a situation could be quite misleading, resulting in late diagnosis and subsequently a delay in timely intervention.Copyright © 2019 Elsevier Inc. All rights reserved.

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