Chronic Neck Pain In A 76 Year Old Female Affecting Balance And Daily Activities

HISTORY: A 76-year old-female presented to her primary care physician with right neck pain for the last 6 months without improvement. She presented with sharp, constant neck pain, rating it at 8/10, radiating up into the occipital region, worse at night, and mildly relieved by Tylenol. She denied any dizziness, numbness, vision, or hearing changes. Conservative management was initially recommended by primary physician, but this did not relieve her symptoms. PHYSICAL EXAMINATION: Examination of the right neck revealed tenderness over the upper cervical spine, lower occiput, and right mastoid process. No swelling and no rash. Extension and lateral flexion to the right was limited to 5 degrees. Rotation of the neck to the right was severely limited to 5 degrees. Flexion was achieved to 10 degrees and lateral flexion to the left was at 10 degrees. Cranial nerves II-XII intact. Upper extremity strength was 5/5 bilaterally. DIFFERENTIAL DIAGNOSIS: 1. Acute mastoiditis 2. Cervical myelopathy/sprain/osteoarthritis 3. Carotid mass TEST AND RESULTS: Cervical spine frontal, lateral and bilateral oblique radiographs:— no compression fracture, C5-C6 and C6-C7 disc space narrowing and uncinate hypertrophy, C5-C6 endplate spurring. Temporal bone CT: — Mastoid air cells and mastoid antrum are patent bilaterally. Unremarkable appearance of temporal bones. Minimal bilateral temporomandibular joint degenerative changes. Inflammatory changes in the sinuses. Cervical spine MRI complete: — partially visualized mass in the right suprahyoid neck which appears to encase the right cervical internal carotid artery. It measures up to 2.7 x 2.2 x 2.8 cmCervical spine CT soft tissue with IV contrast: — avidly enhancing lesion in the right neck which splays the internal and external carotid arteries and is situated at the carotid bifurcation, measuring approximately 2.8 x 2.0 x 3.4 cm. FINAL WORKING DIAGNOSIS: Type III Carotid Body Paraganglioma TREATMENT AND OUTCOMES: 1. Referral to vascular surgery for paraganglioma, but patient no-showed for her appointment. 2. Referral to home physical therapy for degenerative disc disease. 3. Patient has an upcoming follow up appointment on 11/29/23, plan to discuss surgical resection recommendation.