Neck injury

Author: Helen Blackhurst / Editor: Jason M Kendall / Reviewer: Michael Perry / Codes: RP4, SLO1, SLO4, TC2, TP2 / Published: 11/01/2021

A 62-year-old man comes into the Emergency Department (ED) in the early hours of the morning following a fall. He apparently fell over while intoxicated and hit his head on a plant pot. He is complaining that his hands and feet feel like cotton wool and that he is unable to move his arms properly.

On examination he is coherent with an abrasion in the centre of his forehead. He has a marked symmetrical weakness (3/5) in his upper limbs with sensory loss in a glove distribution. Upper limb reflexes and tone are both diminished. He has subtle weakness in his legs (L1 to S1 4/5) and altered sensation over the dorsal surfaces of his feet. Perineal sensation and anal tone is normal:

Initial c-spine x-ray and CT cervical spine shows degenerative change only. CT head is normal.

MRI scan of his neck is shown: