Traumatic Cervical Myelopathy Masked by Alcohol Intoxication and Diagnostic Anchoring

TL;DR

A man's spinal injury was initially missed due to alcohol intoxication and misdiagnosed as other conditions before being correctly identified.

Contribution

This case highlights how alcohol intoxication can delay accurate diagnosis of traumatic spinal injuries.

Findings

Alcohol intoxication led to misdiagnosis of traumatic cervical myelopathy as a stroke or Guillain-Barré syndrome.

A detailed history and physical examination were crucial in identifying the true cause of the injury.

Imaging confirmed a severe spinal cord contusion without bony disruption after an initial fracture was suspected.

Abstract

Acute alcohol intoxication often masks traumatic injuries, leading to diagnostic anchoring and delayed management. We report the case of a 61-year-old male presenting with sudden-onset quadriplegia. Initial clinical suspicion favoured a cerebrovascular accident or Guillain-Barré syndrome due to the patient’s amnesia about a fall and the presence of new-onset atrial fibrillation. A significant diagnostic delay occurred until collateral history from peers revealed a “faceplant” injury, and the retrospective identification of a cutaneous imprint from the patient’s eyeglasses confirmed a hyperextension mechanism. Despite an initial report of a fracture, subsequent imaging confirmed an isolated, severe cord contusion from C3 to C6 without associated bony disruption. This report highlights the importance of the fundamentals of the diagnostic process, including comprehensive history gathering and a thorough bedside examination.

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