Differentials
Arthritis of cervical spine
SIGNS / SYMPTOMS
Pain with passive neck movement, or crepitus, may occur with or without acquired torticollis.
INVESTIGATIONS
Degenerative skeletal changes on neck imaging.
Neck mass
SIGNS / SYMPTOMS
Visible or palpable mass, limited passive range of motion.
INVESTIGATIONS
Mass visualized on neck imaging.
Cerebral mass, lesion or infarct
SIGNS / SYMPTOMS
Neurologic abnormalities (e.g., hemiparesis, asymmetrical reflexes, cognitive, and/or personality changes).
INVESTIGATIONS
Mass lesion or infarct visualized on brain imaging.
Posterior fossa mass
SIGNS / SYMPTOMS
Symptoms provoked by neck extension, prominent headache, nausea, and vomiting, dizziness.
INVESTIGATIONS
Posterior fossa mass visualized on brain imaging.
Retropharyngeal abscess
SIGNS / SYMPTOMS
Systemic signs of infection, dysphagia.
INVESTIGATIONS
Enhancing mass on neck imaging.
Parkinsonian syndromes
SIGNS / SYMPTOMS
Bradykinesia and rigidity beyond neck area, tremor, gait abnormality, postural instability, autonomic instability.
INVESTIGATIONS
Differentiated by clinical exam findings only.
Huntington disease
SIGNS / SYMPTOMS
Hyperkinetic movements involving other body parts and/or cognitive and behavioral symptoms.
Suggestive family history.
INVESTIGATIONS
Detection of ≥36 cysteine/arginine/guanine repeats in the Huntington disease gene.
Tic disorder
SIGNS / SYMPTOMS
Abnormal neck movements accompanied by frequent tics such as blinking, ocular deviations, or sniffing.
INVESTIGATIONS
Differentiated by clinical history and exam findings only. Tics are usually preceded by premonitory urge followed by release of tension with performance.
Dopa-responsive dystonia
SIGNS / SYMPTOMS
Childhood onset.
Responds therapeutically to a trial of levodopa.
INVESTIGATIONS
Differentiated by clinical exam findings only.
Trochlear nerve palsy
SIGNS / SYMPTOMS
Extraocular movements limited.
Diplopia corrected by abnormal head posture.
INVESTIGATIONS
Differentiated by clinical history and exam findings only.
Primary torsion dystonia (DYT-1)
SIGNS / SYMPTOMS
Onset before fourth decade.
Generalized dystonia.
INVESTIGATIONS
Presence of DYT-1 gene mutation.
Wilson disease
SIGNS / SYMPTOMS
Accompanying neuropsychiatric abnormalities.
Kayser-Fleischer rings present on slit-lamp exam.
INVESTIGATIONS
Low serum ceruloplasmin, increased urinary copper excretion, mutation in ATP7B gene.
Psychogenic dystonia
SIGNS / SYMPTOMS
Suggestive symptoms include previous somatization, abrupt onset, secondary gain, and absence of sensory trick.
Psychogenic dystonia is rare and should be diagnosed with caution.
INVESTIGATIONS
Differentiated by clinical exam findings only.
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