Mr. MHS, a 70-year-old Saudi man, was brought to the ER after a car accident. He complained of headache, neck pain, and was confused. Imaging showed old rib and clavicle fractures, as well as degenerative changes and a Grade 2 dislocation of his C5/C6 vertebrae. He was treated conservatively with a neck collar but remained unable to walk. After further review, he was admitted to the neurosurgery unit where he was treated conservatively and later seen walking, though the exact diagnosis remained unclear.

1. A CASE PRESENTATION

2.  Mr. MHS, Saudi, male, aged 70
brought in ER on 09/07/1435 with
history of RTA, His car was overturned
 Complains of headache/pain in the
neck/ no definite history of loss of
consciousness/ no vomiting.
 P/H: No history of Hypertension/DM
 Had previous RTA one year back which
he revealed later.

3.  Patient was conscious but drowsy and
confused, GCS 14
 INJURIES: Extensive lacerated wound
right parietal region of scalp and right
side of the neck.
 Small lacerated wound right hand and
right elbow.
 CHEST: good air entry both side,
suspected fracture right clavicle no
evidence of hemo/pneumothorax.

4.  ABDOMEN: Soft and lax, no
distension, no tenderness or
rigidity, normal bowel sound.
U/S Abdomen: NAD
 CNS: Conscious but drowsy and
confused, GCS:14 can move all
his limbs, No neurological
deficit.

11.  XRAY CHEST: shows fracture of second rib
on right side, most likely old fracture.
Fracture right clavicle this also may be old.
No evidence of hemo/pneumothorax.
 XRAY PELVIS:NAD
 XRAY CERVICAL SPINE: Shows sub-laxation
of C5/C6 vertebra, may be old also.
 PATIENT WAS SENT TO MOHAYEL FOR
URGENT CT BRAIN AND CT CERVICAL SPINE

15. CT REPORT:ATROPHIC BRAIN
CHANGES,
CERVICAL SPINES: MARKED
DEGENERATIVE SPONDYLOTIC
CAHANGES/MARGINAL
OSTEOPHYTIC LIPPINGS/
NARROWING OF DISC SPACE C
5/C6

16.  Hb: 12.4 WBC:11.5
 CREA: 0.8 AMYLASE:38
 AST: 35 ALT: 20
 ALP: 50 ALB: 3.5G
 RBS: 107

17. RTA/HEAD INJURY/GRADE 2
DISLOCATION OF C5/C6
VERTEBRA/ FRACTURE RIGHT
CLAVICLE ?OLD/ FRACTURE
2nd RIB RIGHT SIDE ?OLD

18.  Patient was admitted in ICU
 Treatment given: Cervical collar
 IV Fluids/Inj VELOSEF/Inj Paracetamol/
 Inj Phenytoin
 FAX sent to Neurosurgeon,ACH
 Patient gone to ACH for Neuro-
surgical evaluation on 14/07/35

19.  NEUROSURGEON REPORT:
 CT Brain: NAD
 CT C.Spine: Degenerative
changes, Cord not compensated.
 Advised: Conservative
management
 Neck Collar for 6-8
weeks

20.  Patients consciousness level
improved, but he was not able to sit or
stand.Can move all his limbs.
 Not willing to go home at all/ Even the
attendents refused to take him home.
 REPEAT CT BRAIN AND CERVICAL
SPINE WAS ADVISED

23.  Dilated extra-axial fronto-
parietal spaces ??chronic sub-
dural collections ?brain atroph
 Grade 2 dislocation of C5/C6
Vertebra, Spondylo-
degenerative changes

24.  Another FAX was sent to
Neurosurgery unit to review the
case on 22/07/1435 as patient
was still unable to walk.
 After much struggle, the patient
was accepted for review and
patient was sent on 30/07/1435
and he was admitted there.

25.  After about two weeks I found
my patient walking near our
OPD, He was in ACH for few days
and he was treated
conservatively!
 Still the dilemma remains about
exact diagnosis of the case!!!