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Acute traumatic central cervical spinal cord injury — MRCEM SBA MCQ

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HardNeurological emergenciesAcute traumatic central cervical spinal cord injuryMRCEM SBA

A 72-year-old man falls forwards from a single step, striking his forehead and forcing his neck backwards. He has neck pain and new tingling in both hands. Grip and finger abduction are 2/5 bilaterally; leg power is 4/5 bilaterally. He is unable to pass urine. He is alert, haemodynamically stable and breathing comfortably. CT of the cervical spine shows degenerative canal narrowing but no fracture or dislocation. He remains immobilised and has no MRI contraindication. What is the most appropriate next management plan?

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Correct answer: B — Maintain immobilisation, obtain urgent cervical MRI and request immediate spinal surgical review.

The hyperextension mechanism, disproportionate arm and hand weakness, and urinary dysfunction suggest traumatic central cord syndrome in a patient with cervical canal narrowing. The absence of a fracture on CT does not exclude spinal cord injury. NICE recommends MRI after CT whenever a neurological abnormality could be attributable to cord injury, regardless of the CT findings. Immobilisation must continue, and suspected cord injury warrants prompt specialist spinal surgical involvement and admission under the trauma pathway. ([pubmed.ncbi.nlm.nih.gov](https://pubmed.ncbi.nlm.nih.gov/39480046/?utm_source=openai)) A is initially attractive because neck trauma can cause arterial injury, but the bilateral limb pattern and bladder dysfunction point to the cord; angiography does not replace cord imaging here. It would be appropriate to investigate a separate clinical suspicion of cervical vascular injury. C mistakes a normal bony CT for neurological clearance; outpatient assessment would fit a patient without concerning neurological findings. D preserves immobilisation but repeats a test that cannot adequately assess the suspected cord lesion; repeat CT might help if the original scan were technically inadequate, which is not suggested here. E includes the necessary imaging and review, but NICE advises against methylprednisolone for neuroprotection after acute traumatic spinal cord injury. Steroids would require an independent indication. ([nice.org.uk](https://www.nice.org.uk/guidance/ng41/chapter/Recommendations))

Reference: NICE NG41: Spinal injury—assessment and initial management (17 February 2016; MRI recommendation clarified May 2021) — https://www.nice.org.uk/guidance/ng41/chapter/Recommendations Traumatic Central Cord Syndrome (2024) — https://pubmed.ncbi.nlm.nih.gov/39480046/