A woman in her 20s presents for care after 9 days of sore throat and subjective fevers followed by neck stiffness that developed over the past 2 to 3 days. The pain is exacerbated by swallowing and any neck motion. She has had sore throats before, but never this bad or this long—and never that made her neck stiff. Ibuprofen(Drug information on ibuprofen) has not afforded much symptom relief.
The patient denies cough but does have a slightly runny nose. She has had no vomiting or photophobia. She is otherwise healthy with no previous medical problems, surgeries, or hospitalizations. She takes an oral contraceptive but takes no other prescription medications and has never been pregnant. She has a new boyfriend whom she has been dating for about a month.
The patient’s vital signs are normal, but she has a low-grade fever (temperature, 99.7°F). Eye findings are normal. Her oropharynx appears remarkably normal, and there is no drooling, stridor, trismus, or abnormal voice. She does, however, have a stiff neck with symmetric limited range of motion in all planes and in all directions. Plain films of the neck are done (Figure 1).
What is the differential diagnosis of meningismus—and do any of these conditions typically show up on plain radiography? What—if anything—does this x-ray film show that is abnormal?
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