What causes mild stiffness in neck on right side?

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Posted on Wed, 3 Jun 2015 in Medicines and Side Effects
Question: About 3 days ago, I started to notice mild stiffness in my neck on the right side, which has become progressively sharper through yesterday. It has since plateaued but is quite painful now. I can barely turn my head to the right, and in general movement in any direction has to be done slowly. I can touch my chin to my chest, but only if I take about 15 seconds to get it down there. There is one very local spot about 2" directly below the back of my right ear which is excruciating if pushed hard, or if my head moves rapidly from side to side.
Yesterday I also developed a mild fever (99-100) late in the day, which fell back to 98.0 by the morning, but has climbed back to around 99.4 this evening. It is no worse today than yesterday, possibly slightly better, but I have been taking acetaminophen to dampen the pain and fever.
I am worried that this suggests viral meningitis, but I have essentially no other symptoms often cited on the web -- no nausea, no bright light sensitivity, no rash, no sleepiness, no material headache. I also started taking Lisinopril for high BP (about 140/90 at peak during the day) at this same time, and it is possible that some of this is adjustment discomfort from it (which I have taken in the past and took a couple of weeks to come into balance).
Is this enough of a package of symptoms that I should be getting to the hospital or doctor, or should I just watch it for a while? I am at this stage quite functional, but also pretty darn uncomfortable and a tad worried.
doctor
Answered by Dr. Ahmad Nazzal 1 hour later
Brief Answer:
Not viral meningitis.

Detailed Answer:
DearXXXXX,

Thank you for trusting us in HCM. I will make sure to answer all your questions to the fullest that I know and can.

Short answer I think you can wait before you go to the hospital since you are functional. Nevertheless your primary care physician might prescribe non steroidal anti inflammatory medications which help reduce the pain and relief any muscle tension in your neck due to long wrong posture.

The reason in my opinion is muscle related, which might be due to increased load of stress during work that you mentioned. Try to follow a healthy diet and do some meditation to help relief the stress, go for a walk for 20-30 minutes every day helps increasing your dopamine and seretonin which help reducing your stress levels.

I hope my answer helped you relax and gave you another perspective to address your problem, surfing the net for symptoms might increase your stress levels since mostly they suggest scary reasons for simple problems so it was a good idea to contact us.

Best regards,
Dr. Nazzal

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ahmad Nazzal 32 hours later
Thanks Dr. Nazzai,
I did go to my PCP and she also agreed it is very unlikely to be viral meningitis -- I look pretty well and can bend my neck (albeit very slowly) farther than she would have expected. However, she did take a CBC and observed that my white count is a bit high:

BASO% 0.1 Range: 0.0-1.0 % (Collection Date: 05/12/2015)
EO% 0.2 Range: 0-6.0 % (Collection Date: 05/12/2015)
HCT 47.8 Range: 37.0-51.0 % (Collection Date: 05/12/2015)
HGB 16.3 Range: 12.0-18.0 g/dl (Collection Date: 05/12/2015)
LYC% 11.6 Range: 20.0-50.0 % (Collection Date: 05/12/2015)
MCH 32.0 Range: 26.0-33.0 pg (Collection Date: 05/12/2015)
MCHC 34.1 Range: 32.0-36.0 g/dl (Collection Date: 05/12/2015)
MCV 93.9 Range: 81.0-99.0 fL (Collection Date: 05/12/2015)
MON% 15.0 Range: 0-14.0 % (Collection Date: 05/12/2015)
NEU% 73.1 Range: 37.0-72.0 % (Collection Date: 05/12/2015)
PLT 223 Range: 140-440 /mm3 (Collection Date: 05/12/2015)
RBC 5.09 Range: 4.2-6.3 /mm6 (Collection Date: 05/12/2015)
WBC 12.71 Range: 4.0-11.0 /mm3 (Collection Date: 05/12/2015)


Liver enzymes were normal but bilirubin was a bit high as was blood glucose. My temp this a.m. is 98.5 and my BP was 122/83, not bad on either. However, I feel absolutely miserable and have lost movement in my head/neck. Now I can only turn about 5-8 degrees to the sides or up and down. Interestingly, the pain has shifted from the right side of my neck to the left. I am also incredibly lethargic, though that could be because last night I took a cyclobenzaprine to relax the muscles, on my PCP's suggestion.

My question today is whether this worsening of energy, increased pain, and high WBC suggests it could be meningeal, and if so should I be doing anything other than taking it easy. How would meningeal pain feel? Would it be centered in and along the spine, or could it be fairly peripheral (like the outside of the neck, or even the tops of my shoulders?)

Thanks, XXXXXXX

My concer
doctor
Answered by Dr. Ahmad Nazzal 16 hours later
Brief Answer:
Refer to Hospital

Detailed Answer:
Dear XXXXXXX

Thank you for the follow up, sorry for taking long to respond back. Looking at your CBC, yes, the WBC as you mentioned are slightly elevated.

Classical meningitis clinical picture is headache, neck stiffness, and fever. However not all patients get all symptoms. Most commonly headache, then neck stiffness and fever chills, some even develop seizures and confusion. Symptoms might progress over the first 24 hours, but some people it take them a week.

Now you don't have features to convince me that it is meningitis. Nevertheless since you still have the neck stiffness, you feel worse despite taking muscle relaxants and most importantly you are still concerned regarding it being meningeal. I think you should refer to the ER. In the ER they can reassess neck stiffness (whether the stiffness is indeed from menigeal irriation or other reasons), perhaps they can repeat CBC to a CT and lumber puncture to out role meningitis.

Please feel free to ask any other question, I wish you fast full recovery.

Best regards,
Dr. Nazzal


Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Ahmad Nazzal

General & Family Physician

Practicing since :2011

Answered : 343 Questions

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