Case history
Case history #1
A 44-year-old woman walks into the accident and emergency department with a chief complaint of neck pain and tenderness in the distribution of the trapezius muscle after falling down a flight of stairs. The triage nurse immediately places a hard cervical collar on the patient and helps her to lie flat on a soft stretcher until the doctor can see her. Further questioning reveals that the woman had slipped on a toy at the top of the stairs. There was no alcohol or drug use involved. There was no other pertinent medical history.
Case history #2
An 80-year-old man is brought to the accident and emergency department by paramedics following a high-speed motor vehicle collision. The patient arrives with full in-line spinal immobilisation. The patient complains of excruciating neck pain. Further history reveals that the patient is healthy, taking no medications, and was not under the influence of alcohol or drugs. Neurological examination is normal. CT imaging reveals an undisplaced fracture across the base of the odontoid process of the C2 vertebra.
Other presentations
The majority of patients present immediately following some form of trauma such as a motor vehicle accident, fall, or injury due to sporting activity (particularly rugby, horse riding, trampolining, or diving into swimming pools). Potentially less obvious presentations include patients with stroke who may have had an associated fall and a cervical spine injury that has gone undetected; this should be considered especially when a stroke patient has bilateral signs and symptoms. Similarly, intoxicated patients for whom the history is vague may have head injuries that are consistent with potential cervical spine trauma. Although most patients present at the time of injury, there are reports of patients with significant cervical spine injuries presenting many days or weeks after injury, and the clinician must be vigilant for this possibility.
Use of this content is subject to our disclaimer