🦴 Neck Pain & Stiffness · Torticollis · Meningitis · Retropharyngeal Abscess · Atlantoaxial Instability

Schwartz Clinical Handbook — Chapter 55 · Meningismus · Grisel syndrome · C‑spine trauma · Diskitis · Dystonic reaction · Sandifer

Select onset (acute, subacute), fever, meningismus (Kernig, Brudzinski), torticollis direction, trauma history, neurologic deficits, and retropharyngeal signs → differentiate meningitis, retropharyngeal abscess, cervical adenitis, atlantoaxial rotary subluxation (Grisel), dystonic reaction, congenital torticollis, and diskitis.
⚠️ Red flags: fever + nuchal rigidity + altered mental status → meningitis (stat LP, antibiotics). Stridor / drooling / respiratory distress → retropharyngeal abscess (airway emergency, CT).

📋 Step 1 — Neck pain features & red flags
📌 Diagnostic impressions
📖 Schwartz Ch 55

Select onset, fever, nuchal rigidity, Kernig/Brudzinski, torticollis, drooling, stridor, trauma, and recent URI → differentiate meningitis, retropharyngeal abscess, cervical adenitis, atlantoaxial rotary subluxation (Grisel), dystonic reaction, congenital muscular torticollis, or diskitis.

✔️ Meningitis: fever, nuchal rigidity, Kernig/Brudzinski, AMS.
✔️ Retropharyngeal abscess: fever, dysphagia, drooling, stridor, bulging posterior pharynx.
✔️ Grisel syndrome: torticollis after URI, C1‑C2 rotary subluxation.
✔️ Dystonic reaction: acute torticollis + oculogyric crisis after antiemetic (metoclopramide).
✔️ C‑spine trauma: tenderness, neurologic deficit, mechanism.
📘 Schwartz pearls (Chapter 55)
• Meningitis: Kernig/Brudzinski may be absent in <12 months; identify through general irritability.
• Retropharyngeal abscess: lateral neck X‑ray (prevertebral swelling >7mm at C2). CT for confirmation, IV abx, ENT drainage.
• Dystonic reaction: diphenhydramine (1‑2 mg/kg IM/IV) diagnostic and therapeutic.
• Grisel syndrome: CT neck with rotation views; treat with antibiotics, anti‑inflammatory, possibly traction.