Visual Diagnosis in Emergency Medicine| Volume 43, ISSUE 4, P704-705, October 2012

Persistent Neck Pain after Motor Vehicle Collision

Published:February 08, 2011DOI:
      A 28-year-old woman presented to the Emergency Department complaining of severe neck pain after a motor vehicle collision. Emergency medical services reported damage to both the front and rear of the vehicle. The patient denied significant past medical history, alcohol use, or pertinent review of symptoms. She complained of 10/10 sharp neck pain made worse with any movement. Physical examination revealed only tenderness to palpation of the upper cervical spine (C-spine) in the midline without neurologic deficits. A computed tomography (CT) scan of the C-spine was performed (Figure 1, Figure 2) and showed a small bony fragment at the craniocervical junction on the right, consistent with possible transverse ligament avulsion. The patient was admitted to the neurosurgical intensive care unit and magnetic resonance imaging (MRI) of the C-spine was obtained (Figure 3). The MRI study showed hyperintensity superior to the odontoid that was read as possibly reflecting edema or hemorrhage and was supportive of the suspicion of an avulsion injury, perhaps involving the transverse ligament. The transverse ligament otherwise appeared to be intact.
      Figure thumbnail gr1
      Figure 1Computed tomography scan of the cervical spine in coronal plane showing avulsion fracture of C1 (arrow).
      Figure thumbnail gr2
      Figure 2Computed tomography scan of the cervical spine in transverse plane showing avulsion fracture of C1 (arrow).
      Figure thumbnail gr3
      Figure 3Magnetic resonance imaging study of the cervical spine showing hyperintense signal superior to the odontoid (arrow).
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