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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
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.
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