Symptom: Neck, Stiff

Initial Grading Reminder

CTCAE grading of stiff neck:

Grade 1: Mild symptoms
Grade 2: Moderate symptoms; limiting instrumental ADL
Grade 3: Severe symptoms; limiting self-care ADLs
Grade 4: Life-threatening consequences; urgent intervention indicated

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

How much can you move your neck?  Is the stiffness/pain constant? Is it limiting your ability to take care of yourself? Have you done any unusual activity or notice the stiffness after a specific activity?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have a headache? Have you had any sleepiness, hallucinations, seizures?

This would be consistent with encephalitis.

Do you have fever, chills, or sensitivity to light?

This would be consistent with meningitis

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

  • Click Here for Telephone Triage

    Suggested Intervention

    Patients with moderate or worse stiff neck should be seen.

    Patients with any of the red-flag symptoms should be seen immediately.

  • Click Here for In-Office Triage

    Nursing Assessment of Potential Causes

    Encephalopathy - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient look uncomfortable?
    • Does the patient look ill?
    • Does the patient report headache, fever, tiredness, sleepiness, hallucinations, stiff neck?
    • Signs of infectious cause (lumbar puncture); Obtain brain MRI; Consult neurologist

    Differential Diagnosis

    What do you suspect is the cause of the stiff neck?