A 78-year old female presents to the ED after a fall face-forward out of bed. She complains of bilateral paresthesias and has significant upper extremity weakness. Her CT scans of head and cervical spine are unremarkable and the MRI is shown here, what's the diagnosis? (scroll down for answer)

Answer: Acute cervical spinal cord contusion (small area of hyper-density at level of C4 on MRI)

Traumatic spinal cord injury (TBSI)

• Motor vehicle accidents followed by falls are the most common causes of TSCI

• Risk factors in the older population include cervical spondylosis and osteoporosis

• Monitor for signs of respiratory depression especially with cervical spinal injuries and intervene with airway management with careful spinal immobilization

• Avoid hypotension (MAP > 85) and hypoxia because this worsens outcomes

• Beware of neurogenic shock which presents with bradycardia and hypotension due interruption of sympathetic pathways