Trauma – Neck

Question 0

Gunshot wound to upper zone of neck without indications for surgical exploration – management? If base of neck?

Answer 0

Arteriographic management

Arteriography, esophagogram, esophagoscopy, bronchoscopy

Question 1

Penetrating injury to neck – surgery if?

Answer 1

Surgical exploration if:

1. Expanding hematoma
2. Deteriorating vitals
3. Signs of esophageal or tracheal injury (spitting up blood)

Question 2

Asymptomatic patient with stab wound to upper or middle zone of neck – management?

Answer 2

Observation

Question 3

Patient with severe blunt trauma to neck – get CT if?

Answer 3

CT scan in patients with neurologic deficits or patients with pain to local palpation of cervical spine

Question 4

Hemisection of spinal cord – typical cause? Symptoms?

Answer 4

Clean-cut injury (nice)

1. Paralysis and loss of proprioception ipsilaterally
2. Loss of pain perception contralaterally

Question 5

Anterior cord syndrome – typically seen with? Symptoms?

Answer 5

Burst fractures of vertebral bodies

1. Loss of motor function, pain, and temperature sensation on both sides
2. Preservation of vibration and positional sense

Question 6

Central cord syndrome – typical patient? Typical cause? Symptoms?

Answer 6

Elderly

Forced hyperextension of neck (rear end collision)

1. Paralysis and burning in upper extremities
2. Preservation of function in lower extremities

Question 7

Management of spinal cord injuries?

Answer 7

1. MRI

2. High-dose corticosteroids (debated)