17 yo Football Player with Central Cord Syndrome after Negative Initial Neck Exam

Abstract

HISTORY: A 17 year old HS football receiver was injured when he sustained a hit from the opposing safety. Reported mechanism by opposing player was shoulder to head impact. He fell to the ground in the prone position. He was immediately evaluated on the field by the nearby opposing athletic trainers. He had no LOC, no neck pain on the field, and he denied tenderness to palpation. He complained of having the wind knocked out of him. He reported that he got hit in the back of the leg and it felt odd. He had an ACL brace on his right knee. Care was transitioned to his team athletic trainers. He was turned supine and his helmet was removed. Afterwards, his right arm was noted to be in an awkward position. He could not move his arms or his legs. He had good sensation but had tingling in his upper and lower extremities. He had no prior history of weakness, neck pain, or concussion. His neck was immobilized. He regained motion in the upper extremity, but continued to demonstrate weakness in grip strength. He could not move his lower extremity. On EMS arrival he was spine boarded, and then taken to the ED for further management. PHYSICAL EXAMINATION: He was AO x 3. He had no tenderness over the cervical spinous processes and paraspinal muscles. He had normal sensation of his bilateral extremities. After being turned supine and having his helmet removed, he developed weakness of his upper and lower extremities, but no sensory deficit. Respiratory and Cardiovascular exams were normal. DIFFERENTIAL DIAGNOSIS: 1. Central Cord Syndrome 2. Anterior Cord Syndrome 3. Posterior Cord Syndrome 4. Brown-Sequard Syndrome 5. Concussion 6. Intracranial Hemorrhage 7. Acute disk herniation 8. Epidural Hematoma 9. Syringomyelia TEST AND RESULTS:CT Head, XR C, T, L spine: No fracture or bleed MR C-spine: Congenital stenosis of the spinal canal, with endplate osteophytes/protrusions moderately narrowing the spinal canal to 8 mm at C3-4, with expansile T2 signal suggestive of edema within the cervical spinal cord at C3-4 levels. FINAL/WORKING DIAGNOSIS: Traumatic Cervical Myelopathy superimposed on Congenital Stenosis of Spinal Canal TREATMENT AND OUTCOMES: 1. Immobilization with Miami J Collar 2. Admitted to the hospital for observation. 3. Sensory and strength deficits improved during stay. 4. Transferred to an intensive inpatient activity based rehabilitation facility.