You order a medical work-up (cause of fall), as well as the ubiquitous head and C-spine CT scanning.
About 30 minutes later, the CT tech calls you to review the scan.
The clinical history is classic for a hyperextension injury, and we were surprised there was no neurologic deficit. The classic deficit with this mechanism would be a central cord syndrome. Although the mechanism may not be entirely understood, hyperextention injury leads to injury to the centrally-located cord motor tracts, giving a primary deficit of upper extremity weakness greater than lower extremity weakness. This syndrome can be mistaken for a factitious neurologic defect.
Treatment initially consists of immobilization with a hard collar. This patient was referred to the trauma center to consider spinal stabilization surgery. She remained without neurological deficit. All things considered, a fortunate outcome