Disclosures: Hannie S. Batal, MD: No financial relationships or conflicts of interest
Case Description: The patient presented with severe neck pain and headache upon awakening but denied any recent falls or trauma. Of note, she admitted to being involved in a MVC 40 years ago but wasn’t evaluated. CT showed C1 and C2 vertebral fractures and CTA of the neck revealed occlusion of the left vertebral artery. Remarkably, the patient had no neurological deficits on physical exam. She underwent occiput to C4 posterior spine fusion, was placed in a cervical collar, and transferred to an acute rehab facility for rehabilitation for impairments with functional mobility and self-care.
Setting: Acute rehabilitation hospital.
Patient: A 70-year-old female with multiple cervical fractures of unknown etiology. Assessment/
Results: The cause of her injury is yet to be ascertained. Notably, however, she did admit to a history of alcohol use, reporting that she often consumes 3 cocktails on a nightly basis. Nevertheless, she progressed swimmingly with acute rehab, regaining some functional mobility, and was ultimately discharged home at a minimal assistance-supervision level after 1 week and will continue to benefit from outpatient PT. DEXA scan was ordered and will be performed on an outpatient basis to evaluate for potentially underlying osteoporosis. Further developments will be discussed.
Discussion: To see such impressive fractures unaccompanied by neurological deficits was truly remarkable. Moreover, the force required to produce C1-C2 fractures is quite high, and typically involves a complex mechanism of injury.
Conclusion: This case illustrates the utility of imaging in the evaluation and management of severe head and neck pain. Despite the lack of a high-risk mechanism of injury or neurologic deficits, the immense pain warranted further investigation. This led to the discovery of some truly impressive lesions on imaging, which should always be considered, particularly in the context of alcohol use. The cause of her injuries continues to be a mystery, however, the investigation is still ongoing.
Level of Evidence: Level V
To cite this abstract in AMA style:
Batal HS, Ihim U, Cipriano KJ, Gosai E. Multiple Cervical Spine Fractures of Unknown Etiology with Vertebral Artery Occlusion in an Elderly Patient Without Neurological Deficits: A Case Report [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/multiple-cervical-spine-fractures-of-unknown-etiology-with-vertebral-artery-occlusion-in-an-elderly-patient-without-neurological-deficits-a-case-report/. Accessed November 21, 2024.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/multiple-cervical-spine-fractures-of-unknown-etiology-with-vertebral-artery-occlusion-in-an-elderly-patient-without-neurological-deficits-a-case-report/