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Author: Michelle Mitchell, MS-IV
Geisinger Commonwealth School of Medicine
AAEM/RSA Social Media Committee Member
53 year-old female presents with chief complaint of neck stiffness. She states that while rolling cigarettes the previous day, she had an abrupt onset of a headache, which she describes as diffuse, dull, and of moderate intensity. She denies a thunderclap headache, but states it is “different” than her typical headaches. The pain continues to radiate down the posterior aspect of her neck, and while her headache has improved since yesterday, her neck pain has worsened. She has a significant past medical history of diabetes mellitus type 2, hypertension, morbid obesity, bipolar disorder, and previous deep vein thrombosis (DVT), and takes insulin, metformin, lisinopril, aripiprazole, fluoxetine, and buproprion for her conditions. Family history is remarkable for her maternal grandmother dying from a cerebral aneurysm.
On physical exam, she has a blood pressure of 116/65, heart rate of 100, respiratory rate of 18, and temperature of 36° Celsius. The patient does not appear to be in any apparent distress and is sitting comfortably on the edge of the bed. Her physical exam reveals decreased range-of-motion on lateral neck flexion, and tenderness to palpation along her cervical spine, primarily in the C2 dermatome. The rest of her physical exam, including an in-depth neurological exam, is normal.
