Differential Diagnosis for Ongoing Symptoms

The patient's symptoms of decreased neck range of motion and dizziness 10 days after a head to ground contact injury suggest a complex interplay of potential diagnoses. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Cervical Vertigo: This condition is characterized by dizziness and imbalance following a neck injury, which aligns with the patient's history of head to ground contact and subsequent neck pain and limited range of motion. The mechanism of injury and the persistence of symptoms support this diagnosis.

• Other Likely Diagnoses

  • Trigeminal Migraine: Although less directly related to the mechanism of injury, migraines can be triggered by trauma and may present with dizziness and neck pain. The absence of typical migraine headache does not rule out this diagnosis.
  • BPPV (Benign Paroxysmal Positional Vertigo): While BPPV is more commonly associated with inner ear issues, head trauma can cause BPPV. However, the lack of nystagmus and the specific trigger of positional changes make this less likely compared to cervical vertigo.

• Do Not Miss Diagnoses

  • Undiagnosed Cervical Fracture: This is a critical diagnosis to consider due to the potential for serious complications, including spinal cord injury. The initial altered consciousness and ongoing neck pain necessitate thorough evaluation to rule out a fracture.
  • Cervical Spine Ligamentous Injury: Similar to a fracture, a ligamentous injury could lead to instability and potentially severe neurological consequences if not properly diagnosed and managed.

• Rare Diagnoses

  • Vertebral Artery Dissection: Although rare, this condition can occur after neck trauma and may present with dizziness among other symptoms. It's a significant diagnosis to consider due to the risk of stroke.
  • Post-Concussion Syndrome with Vestibular Symptoms: While the patient had altered consciousness initially, the focus on neck symptoms might overshadow a concussion. Some patients develop vestibular symptoms post-concussion, which could contribute to the patient's dizziness.