Module 28, General Medical Level
The patient is a 4 year old male who developed an insidious onset of
neck pain and stiffness 4 days prior to admission. Over the intervening
period, the patient suffered from worsening of his symptoms which led to
increasing irritability and difficulty sleeping. On the day of admission,
he developed severe neck pain. It was observed that his head was in a fixed
position just slightly right of midline. The patient's past medical history
was remarkable for two recent self-limited episodes of hives and urticaria
on his trunk and extremities that was treated with prednisone. There was
vague history of remote trauma about one month previously when the patient
had been "horsing" around with his brother. The child had no
evidence of a viral prodrome, constitutional symptoms or travel history.
Question 28A
The differential diagnosis includes the possibility of cervical spinal
cord tumor.
Question 28B
Although
the child has no signs of acute sepsis this type of symptom complex can
be caused by an inflammatory process in the retropharyngeal space.
Question 28C
A
bony dislocation in the cervical spine can occur without evidence of trauma
and often has this type of presentation.
Question 28D
The
best imaging study to start the evaluation process for this deformity is
an MRI.
Question 28E
A
lyme titer should be obtained because this presentation is consistent with
acute Lyme arthritis involving the cervical spine.
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