Associate Professor Penn State Health Hummelstown, Pennsylvania, United States
Case Diagnosis: Severe cervical cord compression from blunt head trauma
Case Description: A 35-year-old male with diabetes mellitus, morbid obesity, and hypertension incurred an anterior head strike while unloading a 250lb sofa at work. He did not lose consciousness and was asymptomatic immediately after the injury. The following day, he reported headaches with associated nausea and dizziness and went to the emergency department. CT head and cervical spine XR were non-focal. He was prescribed sumatriptan and was discharged on the same day.
After one month, he was referred to physical medicine and rehabilitation for a concussion evaluation. He reported a diffuse headache, cervicalgia, and balance difficulties. Upon physical examination, his higher mental function, cranial nerves, reflexes, strength, and sensation were intact. Hoffman’s test was negative. However, dual and single limb Rhomberg tests were positive. The patient was prescribed physical therapy for cervical stabilization and balance training.
Discussions: After 3 months of physical therapy and conservative treatments, the patient continued to have severe cervicalgia, headaches, and balance difficulties. An MRI brain and MRI cervical spine were ordered and revealed severe C5-C6 cord compression from a large disc protrusion without an intracranial abnormality. He was referred to neurosurgery who performed a decompressive C5-C6 anterior diskectomy and fusion. One month after surgery, his headaches and balance difficulties were completely resolved.
Conclusions: Cervical cord injury occurs in approximately 4-8% of blunt head trauma cases. In this case, the patient had the absence of upper motor neuron injury, weakness, and sensory loss; however, gait and balance impairments persisted. Subjective gait disturbance has been reported to have a strong positive correlation with the severity of cervical cord compression. For patients with blunt head trauma in the absence of classic focal neurological deficits, it is important to properly evaluate for cervical spine injury, especially in the setting of ongoing gait and balance dysfunction.
