Pediatric emergency medicine trisk 0971 0971
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Collagen Vascular Disease. Collagen vascular disease (see Chapter 101
Rheumatologic Emergencies ) may involve the cervical spine and lead to neck
stiffness and/or pain. Children with juvenile idiopathic arthritis (JIA) may have
either insidious or acute onset of symptoms, which commonly include neck
stiffness. Cervical involvement is a late finding in ankylosing spondylitis and
other spondyloarthropathies. However, girls with psoriatic arthritis may have
cervical involvement preceding sacroiliac and lumbar involvement.
Other Infectious/Inflammatory Conditions. Pharyngotonsillitis, upper
respiratory tract infections, otitis media, and mastoiditis may be associated with
neck pain. Torticollis may occasionally be seen with these conditions and may be
accompanied by Grisel syndrome as well. If neck pain is posterior in location and
accompanied by fever, the diagnosis of meningitis should be strongly considered.
The diagnosis of viral myositis involving the neck can be made only after
excluding the possibility of meningitis in a child with neck pain and fever. Upper
lobe pneumonia may cause pain referred to the neck with or without associated
stiffness. Although rare, acute suppurative thyroiditis may cause neck pain and
stiffness and is associated with fever and a palpable, swollen thyroid gland.
Neck Stiffness Associated With Tumors, Vascular Lesions of
the Central Nervous System, or Other Space-Occupying
Lesions
Potentially Life-Threatening Causes
Space-occupying lesions of the brain and spinal cord may lead to neck stiffness,
malposition, and/or pain. Even if the histology of these lesions is benign, they are
potentially life threatening because of the complications of intracranial pressure
elevation and the potential for brain and spinal cord compression. Ruptured
aneurysms may cause subarachnoid hemorrhage with associated neck stiffness.
Brain Tumors. Children with tumors of the posterior fossa, the most common
location for pediatric brain tumors, may present with head tilt, neck stiffness, or
torticollis. Posterior fossa tumors may cause many other symptoms and signs
(e.g., vomiting, headache, ataxia, disturbances in vision including diplopia,
papilledema, cranial nerve deficits, corticospinal or corticobulbar signs). Head tilt
may result from attempts to compensate for diplopia. However, neck stiffness is
believed to result from irritation of the accessory nerve by the cerebellar tonsils
trapped in the occipital foramen or by tonsillar herniation.
