Differential Diagnosis
The patient's presentation of right-sided neck pain, vertigo, and a family history of Chiari malformation suggests several potential diagnoses. Here's a categorized differential diagnosis:
- Single Most Likely Diagnosis
- Cervicogenic vertigo: This condition is characterized by vertigo caused by cervical spine disorders, which could be related to the patient's neck pain. The fact that the pain is reproducible and causes vertigo supports this diagnosis.
- Other Likely Diagnoses
- Cervical spondylosis: This condition involves wear and tear on the cervical spine, which could cause neck pain and vertigo.
- Herniated cervical disc: A herniated disc in the cervical spine could compress nerves, leading to neck pain and vertigo.
- Chiari malformation: Given the family history, it's possible that the patient has a Chiari malformation, which could cause vertigo and neck pain.
- Do Not Miss Diagnoses
- Vertebral artery dissection: This is a potentially life-threatening condition that could cause vertigo and neck pain. Although less likely, it's crucial to consider due to its severe consequences.
- Multiple sclerosis: While less common, multiple sclerosis could cause vertigo and neck pain, especially if there are other neurological symptoms.
- Cervical spine infection or abscess: Infections or abscesses in the cervical spine could cause neck pain and vertigo, and are important to rule out due to their potential severity.
- Rare Diagnoses
- Ehlers-Danlos syndrome: This genetic disorder affects connective tissue and could cause cervical spine instability, leading to neck pain and vertigo.
- Cervical dystonia: A rare condition characterized by abnormal neck movements, which could cause neck pain and vertigo.
- Craniocervical junction anomalies: Other anomalies in the craniocervical junction, such as atlantoaxial subluxation, could cause vertigo and neck pain.
Each of these diagnoses has a brief justification, and the categorization is based on the likelihood of each condition given the patient's symptoms and history. The "Do Not Miss" category includes diagnoses that may be less likely but have significant consequences if missed.