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Neck Pain

UNFINISHED CASE: COME BACK LATER  Scroll to bottom for case answer and E-meducation 

History: A 71-year-old female presents to the ED with 2-3 weeks of constant waxing and waning bilateral neck pain with no associated fever, weakness, numbness, chest pain or shortness of breath.  She doesn’t volunteer it but when probed does endorse occasional chills. ?She also had an episode of dry heaving but no vomiting once today.

Exam: Vital signs were normal, but you notice that the temperature is 99.1 (this is why you ask about chills).  Physical exam was normal except for restricted range of motion to the neck which exacerbated pain.  Neurologic exam was normal

Initial Concern(s): Cervical strain, epidural abscess

Testing: See image BELOW or ABOVE

 

QUESTIONS:

  1. What does the case image image show?  (click two times to enlarge)
  2. What should you do next?  
  3. Where can I get a quick refresher on this topic?  See highlighted area below

Scroll to bottom for case answer and E-meducation 

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ANSWERS:

  1. What does the case image image show?  See highlighted area below
  2. What should you do next?  Order an MRI of the cervical and thoracic spine with contrast.  The C-spine MRI was normal but the T-spine showed findings concerning for early discitis osteomyelitis at T9-10
  3. Where can I get a quick refresher on this topic?  See highlighted area below

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E-meducation for medical topic of this case: Read the yellow highlighted area of the page-shot below from our #1 title, the Emergency Medicine 1-Minute Consult Pocketbook

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