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Case Study: Neck pain

CC: "Neck pain"

HPI:
52 year old male presents complaining of neck pain. Patient reports feeling lightheaded while urinating. States he reached back to steady himself on the towel rack and the next thing he remembers he is lying in the shower stall with his neck "crunched up" on his chest. Patient proceeded to pick himself up, reporting neck pain, and continued with his morning activities. When the pain did not go away 60 minutes later he had his wife drive him to the ED and he walked in for evaluation. Patient initially denied any LOC but on further questioning did not have full recall of events, denies any numbness or tingling, denies bowel or bladder incontinence.

VS: HR 60, RR 14, BP 110/70, SaO2 100% room air

PE:
HEENT: NCAT, PERRLA
Neck: bony tenderness C4-C5, paraspinal tenderness bilaterally along cervical spine
Rectal:mildly diminished rectal tone
Neuro:mildly diminished sensation to pinprick on right C5-T10, 5/5 motor strength, 2+ DTR throughout

QUESTION:
What are the radiographic findings?

RESULTS/DISCUSSION:

 

 

 

 

 

 

 

 

RESULTS:
HCT: negative for intracranial bleed, C-spine series: (view large image)
CT of cervical spine: (photo to come)

ANSWER/DISCUSSION:
This patient has a bilateral facet dislocation (unstable injury) of C4 caused by disruption of the posterior ligamentous complex during distraction (when patient lost consciousness) and hyperflexion, and a wedge fracture (stable) of C5. Patient was flown to area Spinal Trauma Center where he was placed in a Halo and scheduled for cervical fusion.

• Patients can present with minimal neurologic deficits yet have potentially devastating neurologic injuries.

• While the neurologic injury is quite impressive, the cause of his syncopal episode must still be sought.

Case courtesy of Susan O'Malley, M.D.