Friday Night Palsy, Saturday Morning Mystery

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Friday Night Palsy, Saturday Morning Mystery - Page #3

Lab Studies: Complete blood count: white blood cells 5.83, hemoglobin 12.3, hematocrit 36.6, platelets 181 Comprehensive metabolic panel: alanine transaminase 65, aspartate transaminase 73, otherwise normal electrolytes and renal function Coagulation studies: prothrombin time 14.4, international normalized ratio 1.09, Partial thromboplastin time 27 Urine drug screen: Negative Other Studies: 1. Computed tomography (CT) of the brain ruled out any intracranial hemorrhage. 2. CT of the spine did not show any evidence of fractures or subluxation. The patient had normal alignment and cervical lordosis, no anatomical abnormalities. 3. Magnetic resonance imaging (MRI) of the brain further ruled out any intracranial pathology. Case Photo #1 4. MRI of the spine showed no evidence of fracture or subluxation, ligamentous injury, or evidence of cord contusion. There was a broad-based disc bulge at C3-C4 with normal central canal diameter. Case Photo #2 Case Photo #3 The narrowest portion of the spinal canal was 9.7 mm (TORG ratio >0.85) meaning no significant stenosis. Of note, the MRI was performed 1 hour from the time of injury, which is clinically relevant because we should start to see evidence of cord edema/injury on MRI at this time. 1. CT of the brain ruled out any intracranial hemorrhage. 2. CT of the spine did not show any evidence of fractures or subluxation. The patient had normal alignment and cervical lordosis, no anatomical abnormalities. 3. MRI of the brain further ruled out any intracranial pathology. 4. MRI of the spine showed no evidence of fracture or subluxation, ligamentous injury, or evidence of cord contusion. There was a broad based disc bulge at C3-C4 with normal canal diameter. The narrowest portion of the spinal canal was 9.7 mm, (TORG ratio >0.85) meaning no significant stenosis. Of note, the MRI was performed after 1 hour of the injury, which is clinically relevant because we should start to see evidence of cord edema/injury on MRI at this time. Consultations: Sports Medicine Trauma Team Neurosurgery Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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