Differential Diagnosis for Neck Stiffness in an 89-year-old Man
Single most likely diagnosis
- E) Normal aging: This is the most likely cause of the patient's symptoms, as mild restriction of neck movement can be a normal part of the aging process. The patient's age and lack of other significant symptoms support this diagnosis.
Other Likely diagnoses
- D) Torticollis: Although less likely, torticollis is a possible cause of neck stiffness, especially if the patient has a history of muscle spasms or injury. However, the patient's symptoms are mild and do not indicate a significant deviation of the neck.
- A) Parkinson disease: While Parkinson's disease can cause stiffness, it is typically accompanied by other symptoms such as tremors, bradykinesia, and rigidity, which are not present in this patient.
Do Not Miss diagnoses
- B) Progressive supranuclear palsy: Although rare, progressive supranuclear palsy is a serious condition that can cause neck stiffness, among other symptoms. It is essential to consider this diagnosis, as early recognition and treatment can improve outcomes.
- C) Stiff-person syndrome: This is a rare condition characterized by progressive stiffness and rigidity, often with a significant impact on quality of life. While unlikely, it is crucial to rule out this diagnosis due to its potential severity.
Rare diagnoses
- Other rare conditions, such as cervical dystonia or inflammatory myopathies, could also cause neck stiffness. However, these diagnoses are less likely given the patient's age, lack of other symptoms, and normal physical examination findings.
- Cervical spine infection or malignancy: Although extremely rare, it is essential to consider these possibilities, especially if the patient's symptoms worsen or if other concerning features develop.