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Suspected traumatic central cord syndrome — MRCEM SBA MCQ

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HardTraumaSuspected traumatic central cord syndromeMRCEM SBA

A 72-year-old man is assessed at a major trauma centre after falling forwards and striking his forehead. His neck was forced into extension. He is alert, haemodynamically stable and has no respiratory compromise. Since the fall, he has been unable to grip with either hand and has developed difficulty passing urine. Power is 3/5 in both upper limbs and 4+/5 in both lower limbs. CT cervical spine, reported by a consultant radiologist, shows degenerative canal narrowing but no acute fracture or malalignment. Full in-line spinal immobilisation remains in place. What is the most appropriate next management plan?

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Correct answer: B — Maintain immobilisation, request urgent cervical MRI, and contact spinal surgery.

The hyperextension mechanism, pre-existing cervical canal narrowing, upper-limb weakness disproportionate to lower-limb weakness and new urinary difficulty strongly suggest traumatic central cord injury. A normal CT for acute bony injury does not exclude spinal cord injury. NICE recommends MRI after CT whenever a neurological abnormality could be attributable to spinal cord injury, regardless of whether CT shows an abnormality. Immobilisation should therefore continue, and the trauma team should immediately involve the on-call spinal or neurosurgical surgeon. ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/37524347/?utm_source=openai)) **A:** CT angiography would address suspected cervical vascular injury, not the principal concern raised by this bilateral cord-pattern deficit. **C:** Repeat CT may be useful if the first scan is inadequate, but this scan has been adequately interpreted and repeating it will not assess the cord appropriately. **D:** Absence of fracture does not justify removing immobilisation while a traumatic cord injury remains suspected. **E:** Neurology may contribute later if an alternative diagnosis emerges, but it does not replace immediate spinal surgical assessment in this case. ([nice.org.uk](https://www.nice.org.uk/guidance/ng41/chapter/Recommendations))

Reference: NICE NG41: Spinal injury—assessment and initial management, recommendations 1.4.4, 1.5.7 and 1.6.2 (17 February 2016; MRI recommendation clarified May 2021) — https://www.nice.org.uk/guidance/ng41/chapter/Recommendations Five-year mortality after traumatic central cord syndrome in Wales (1 August 2023) — https://pubmed.ncbi.nlm.nih.gov/37524347/