Correct!
5. All of the above
In this case, many incorrect diagnoses were sequentially made:
In each case, our physical examination was incomplete, but serial physical examination prompted rethinking of the differential diagnosis, eventually arriving at the correct and somewhat obscure explanation of the patient’s symptoms and signs, leading to correct management.
Central cord syndrome is generally associated with a favorable prognosis for some degree of neurological and functional recovery. It can closely mimic stroke (2). The benefits of early surgical decompression in the setting of ATCCS remain controversial due to the lack of clinical randomized trials but recent studies suggest that early surgery (less than 72hours after trauma) appears to be safe and effective, especially for patients with evidence of focal anatomical cord compression (1).
The physical examination is difficult at times, and an ongoing job –it may not be complete after the initial history and physical examination. The patient's shoulder pain had some features to suggest that it was radicular rather than musculoskeletal. Anatomically a right C4-C6 epidural hematoma might be expected to cause right shoulder radicular pain. Perhaps more importantly, listen to the nurses. In this case, it was the nurses who noted the change in the neurological examination that led to the diagnosis.
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