Natural Tricks to Heal a Stiff Neck
Cervical radiculopathy is a common cause of neck pain, and can be caused by a herniated cervical disc, osteophytic changes, compressive pathology, or hypermobility of the cervical spine. The lifetime prevalence of neck and arm pain among adults may be as high as 51 . Risk factors associated with neck pain include heavy lifting, smoking, diving, working with vibrating heavy equipment, and possibly riding in cars.70 Cervical nerve roots exit the spine above the corresponding vertebral body (e.g., the C5 nerve root exits above C5). Therefore, disc herniation at the C4-C5 interspace causes symptoms in the distribution of C5.71 Radicular symptoms may be caused by a soft disc (i.e., disc herniation) or by a hard disc (i.e., osteophyte formation and foram-inal encroachment).71 The most commonly involved interspaces are C5-6, C6-7, C4-5, C3-4, and C7-T1.70
On physical examination, radicular pain increases with certain maneuvers such as neck range of motion, Valsalva maneuver, cough, or sneeze. Active and passive neck range of motion is tested, examining flexion, rotation, and lateral bending. Spurling's maneuver is useful in assessing neck pain the examining physician flexes the patient's neck, then rolls the neck into lateral bending, and finally extends the neck. The examiner then applies a compressive load to the vertex of the skull. This maneuver narrows the cervical foramina posterolateral , and may reproduce the patient's radicular symptoms.
The major neurological features of Down's syndrome are developmental delay and severe, diffuse muscular hypotonia, which affects most patients. Convulsive disorders are also more commonly present in these patients. The pathogenesis of the convulsive activity in this population is probably multifactorial and may result from a combination of medical risk factors and inherent neurological abnormalities. As individuals with Down's syndrome age, however, other neurological signs may appear. About 20 percent of patients complain of neck pain or discomfort, and they may demonstrate torticollis, gait impairment, or corticospinal tract dysfunction. These features are believed to be related to atlantoaxial subluxation and instability and result in compression of the medulla and spinal cord.
Patients who developed paralytic poliomyelitis may initially have had clinical symptoms of fever, malaise, headache, and gastrointestinal or upper respiratory tract symptoms. These symptoms subsided, only to recur after several days in association with increasing signs of meningeal irritation, headache, and stiff neck. When the illness progressed to the paralytic form, muscle soreness was prominent, particularly in the back and neck. Patients who developed paralysis usually did so on the second to fifth day after meningeal signs and fever became evident. Once weakness began, it typically progressed for only the first few days after its onset. The fever persisted for several days but often subsided before the paralysis was complete. Patients complained of severe muscle pain and spasms with asymmetrical flaccid muscle weakness that usually affected a lower extremity. Severe bulbar weakness occurred in 10 to 15 percent of patients with paralysis. The disease was most common in...
Crescendo orbital pain or frontal headache can herald impending internal carotid artery occlusion presumably from irritation or ischemia to peripheral trigeminal branches. Similarly, a cluster of symptoms including facial, orbital, or neck pain or facial paresthesias in association with an ipsilateral Horner's syndrome may reflect dissection of the cervical portion of the internal carotid artery. y These symptoms may also be prodromal. Excruciating pain in the supraorbital headache in association with a pupil involving third nerve palsy is almost pathognomonic for an intracranial (especially posterior communicating artery) aneurysm. Ipsilateral orbital or ocular pain has also been reported in association with posterior cerebral artery occlusion, which may reflect ischemic damage to regions of the tentorium adjacent to the occipital lobes that are innervated by V1.
Figure 8-8 A, Computed tomography scan showing massive invasion of larynx, trachea, and esophagus by rapidly growing thyroid carcinoma of mixed Hurthle cells and anaplastic histopathology. This 71-year-old man was effectively palliated by cervicomediastinal exenteration for airway obstruction, with voice loss, total dysphagia and odynophagia, and head and neck pain. Mediastinal tracheostomy was established. With this histology, palliation was alone the goal. B, Gross surgical specimen of poorly differentiated squamous carcinoma of the thyroid in a 69-year-old man, similarly treated. He learned to use an electronic larynx well enough to continue to serve as town moderator. He died 6 years later of coronary disease, without recurrence of the thyroid cancer.
Clinical Features and Differential Diagnosis. The classic presentation of bacterial meningitis is headache, fever, stiff neck, and an altered level of consciousness, but may also be ataxic as a result of labyrinthine dysfunction or vestibular neuronitis. In adults, an upper respiratory tract infection frequently precedes the development of meningeal symptoms, and its presence should be sought in the history. '7 , y Adults typically complain of headache, photophobia, and stiff neck, and they may have a rapid progression from lethargy to stupor and coma. The clinical presentation of meningitis in an older adult consists of fever and confusion, stupor, or coma. Cranial nerve palsies, and most notably sensorineural hearing loss, are a common complication of bacterial meningitis and may be present early in the course of the illness. A stiff neck is the pathognomonic sign of meningeal irritation, resulting from a purulent exudate or hemorrhage in the subarachnoid space. Nuchal rigidity or...
Radiculopathy is generally associated with back or neck pain radiating into an extremity. The pain is poorly localizing for nerve root level but typical in the fact that it is radiating. There will generally be a loss of all modalities of sensation in a dermatomal distribution, a corresponding weakness in a myotomal distribution (i.e., with ventral root involvement as well), and segmental hyporeflexia. The most common cause is a herniated disc or osteophyte compressing on a nerve root. A structural lesion such as a neurofibroma or a metastatic focus must also be taken into consideration as possible causes.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly beneficial in relieving acute neck pain. However, side effects are common, and usually two or three medications must be tried before a beneficial result without unacceptable side effects is achieved. Muscle relaxants help relieve muscle spasm in some patients alternatives include carisoprodol (Soma), methocarbamol (Robaxin), and diazepam (Valium). Narcotics may be useful in the acute setting, but should be prescribed in a strictly time-limited man-ner.76 The physician should be alert to the possibility of addiction or abuse.
Most patients with whiplash injuries have negative diagnostic studies but improve, although slowly and irregularly. Patients benefit from a program of rest, immobilization, neck exercises, and return to function. At two-year follow-up, approximately 82 of patients with whiplash injury can expect to be symptom-free. Patients with persistent symptoms are older, have more signs of spondylosis on cervical radiographs, and probably sustained more severe initial injuries. Patients symptomatic at two-year follow-up initially reported more pain, a greater variety of pain symptoms, had higher rates of pretrau-matic headache, and had more rapid onset of postinjury symptoms. Symptomatic and asymptomatic patients were similar with regard to gender, vocation, and psychological variables.88 Some patients who sustain a whiplash injury never recover completely, probably due to a combination of the severity of the injury, underlying cervical abnormalities, and psychosocial factors.81
This arrangement accounts for the strictly unilateral nature of some types of headache. The pain is poorly localized because of large receptive fields, and is referred to somatic areas. In many respects, headache is little different from the pain experienced in association with inflammation of other viscera. Just as appendicitis is accompanied by referred pain to the umbilicus and abdominal muscle rigidity, so headache is generally referred to the frontal (ophthalmic) or cervicooccipital (C2) regions and is associated with tenderness in the temporalis and cervical musculature. It is because of this arrangement that tumours in the upper posterior fossa may present with frontal headache and why patients with raised pressure within the posterior fossa and impending herniation of the cerebellar tonsils through the foramen magnum may complain of neck pain and exhibit nuchal rigidity. Central projections of the trigeminal nerve to the nucleus of the tractus solitarius account for the...
Adulteration of heroin with chloroquine can cause headache, confusion, and visual disturbances. Spongiform encephalopathy has also been reported. In these patients, there were symptoms of apathy, bradyphrenia, dysarthria, and ataxia. There are also signs of spastic hemiparesis or quadriparesis, tremor, chorea, myoclonus, pseudobulbar palsy, fever, and blindness. Heroin use is also a risk factor for new-onset seizures independent of head injury, infection, stroke, or alcohol. Infections are a common cause of morbidity in heroin users. Osteomyelitis is associated with back or neck pain, radiculopathy, and sometimes even cord compression. Cervical infection is especially common among addicts who inject into the jugular vein. Symptoms frequently precede diagnosis by several weeks. Staphylococcus aureus and Pseudomonas are common etiological factors in these infections. Bacterial endocarditis can lead to intraparenchymal or extraparenchymal abscess of the brain or spinal cord, meningitis,...
Clinical Features and Associated Disorders. Patients with ependymomas have symptoms corresponding to the part of the neuroaxis affected by the tumor. For example, tumors arising in the spinal cord can lead to localized back pain, sensory disturbances with a demonstrated dermatomal line, weakness of both legs, or disturbances of bowel or bladder control. Ependymomas arising in the fourth ventricle, brain stem, or lateral ventricles can present with evidence of headaches or other symptoms of hydrocephalus (especially nausea and vomiting), ataxia, and increasing head circumference. Neck pain and behavioral changes also are common presenting complaints in children. Because ependymomas may be present for as long as 3 to 6 months before they come to clinical attention, symptoms may sometimes be labeled chronic.
Acute symptomatic syphilitic meningitis was first described by H. Houston Merritt in 1935. y The most common symptoms of syphilitic meningitis are headache, nausea and vomiting, and stiff neck. In Merritt's review, papilledema was frequently present resulting from acute hydrocephalus associated with meningeal inflammation with increased ICP. Papilledema is not a common finding today. Abnormalities of cranial nerves II, VI, VII, and VIII are common. The meningeal symptoms typically develop within 1 to 2 years of the initial infection. y Examination of the CSF in cases of syphilitic meningitis reveals an increased opening pressure, a lymphocytic pleocytosis, a normal or slightly decreased glucose concentration, an elevated protein concentration, and a positive VDRL test. A nonreactive CSF-VDRL test does not rule out neurosyphilis. A reactive CSF-VDRL test virtually confirms the diagnosis of neurosyphilis except when the CSF is blood tinged. Blood in the CSF may give a false-positive...
Herpangina is an acute febrile disease that occurs mainly in children in the summer months. The first complaints are fever, headache, sore throat, nausea, and stiff neck. Blisters are seen in the throat that are approximately 2 mm in size and surrounded by an intense erythema. These lesions may coalesce, and some may ulcerate. The course is usually 7 to 10 days. The complaints include fever, nausea, vomiting, diarrhea, sore throat, cough, and stiff neck. A measles-like eruption occurs in one third of cases. Small erosions may develop on the mucous membranes of the cheek. Echoviruses 9 and 4 have been isolated from most cases with skin lesions.
Cerebellar Tonsillar Herniation Syndrome. Posterior fossa masses produce most of their findings by compression of the brain stem and cranial nerves, and by obstructive hydrocephalus. As the pressure gradient across the foramen magnum increases, however, the cerebellar tonsils may be pushed into, and eventually through, the foramen. This compresses the medulla and may produce apnea by inducing dysfunction in the medullary respiratory centers. Before losing consciousness, patients with cerebellar tonsillar herniation may complain of a stiff neck.