Differential Diagnosis for a 44-year-old Female with Developmental Disability and Stiff Painful Neck
Single most likely diagnosis:
- Dystonic reaction: This is a likely diagnosis given the patient's symptoms of a stiff and painful neck, and the fact that she is on Geodon (ziprasidone), an antipsychotic medication known to cause dystonic reactions as a side effect. The patient's developmental disability and inability to communicate may also make it more challenging to recognize and report symptoms, potentially leading to a delayed diagnosis.
Other Likely diagnoses:
- Cervical spine injury or strain: Given the patient's developmental disability, she may be at higher risk for falls or other injuries that could result in a stiff and painful neck.
- Meningitis: Although less likely, meningitis is a possible cause of a stiff neck, especially if the patient has a fever or other signs of infection.
- Cervical spondylosis: This is a common condition that can cause neck pain and stiffness, especially in older adults.
Do Not Miss diagnoses:
- Meningitis or subarachnoid hemorrhage: These are life-threatening conditions that require immediate medical attention. Although they may not be the most likely diagnoses, they cannot be missed due to the potential for severe consequences.
- Cervical spine fracture or instability: This is a potentially life-threatening condition that requires prompt diagnosis and treatment to prevent further injury.
Rare diagnoses:
- Tetanus: This is a rare but potentially life-threatening condition that can cause muscle stiffness and rigidity, including in the neck.
- Sandifer syndrome: This is a rare condition that can cause torticollis (a twisted neck) and is often associated with gastrointestinal disorders, such as gastroesophageal reflux disease (GERD).
- Neuroleptic malignant syndrome (NMS): This is a rare but life-threatening condition that can be caused by antipsychotic medications like Geodon, and is characterized by muscle rigidity, fever, and altered mental status.