What’s the diagnosis? #11

This gentlemen fell asleep on the toilet and fell off bumping his head. There was no LOC. There should be enough information in the first x-ray to guess at least one diagnosis which in this context should lead to the second.

https://gmep.org/media/12308

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The underlying diagnosis is ankylosing spondylitis. The c-spine x-ray shows  the bamboo spine appearance pretty well.

If someone has ankylosing spondlylitis then they’re incredibly high risk for spinal fractures in the context of even minor trauma like this.

Outcome

The inadequate nature of the plain film was recognised (I can only see to C6) and a CT was obtained.

https://gmep.org/media/12309

Hopefully that’s a fairly obvious fracure to most of us.

I’ve seen a few of these c-spine fractures in people with bamboo spines and they seem to do fairly poorly. The other thing is to be careful with immobilisation. If your neck is normally in a hyperflexed position then ramming it back into a neutral position with a collar seems a terrible idea. I tend to immobilise these guys in position of comfort – be that partially sitting up with a folded sheet to support the head and allow immobilisation with blocks or collar.

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About Andy Neill

EM Reg/Resident based near Dublin. Former anatomy lecturer, theology student and occasional musician @andyneill | + Andy Neill | Contact

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