Bilateral isolated C5 paralysis of the shoulder: Atypical presentation of a transdiscal C4-C5 cervical spine fracture.
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1 mars 2021
- doi: 10.1136/bcr-2020-236323
- issn: 1757-790X
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Paresis Palsy Diseases--ImagingCiter ce document
E. Mareddu et al., « Bilateral isolated C5 paralysis of the shoulder: Atypical presentation of a transdiscal C4-C5 cervical spine fracture. », Serveur académique Lausannois, ID : 10.1136/bcr-2020-236323
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After a low-energy fall, an 83-year-old man presented with bilateral weakness of the upper arms without loss of sensation associated with a rigid cervical spine (ankylosing spinal disorder, ASD). Because of an atypical presentation during history, examination and initial imaging, a late diagnosis of a transdiscal C4-C5 fracture was made by dynamic radiographs. Anterior cervical discectomy and fusion were performed with delay. Strength improved from grade C to D (American Spinal Injury Association classification) after surgery. To our knowledge, this is the first description of a bilateral, isolated upper limb C5 paralysis without any loss of sensation caused by a transdiscal C4-C5 fracture. A high clinical and diagnostic index of suspicion is mandatory to make the diagnosis. We present three clinical 'Awareness Criteria' (1: recognition of ASD; 2: high index of fracture suspicion; 3: necessary imaging) helping clinicians to safely and promptly diagnose occult spinal fractures in ASD.