title: Delay in spinal cord injury diagnosis due to sedation: a case report.
abstract: BACKGROUND
  In the United States, the incidence of traumatic spinal cord injury is estimated to be approximately 40 per one million persons per year. The most common causes of traumatic spinal cord injury are motor vehicle collisions, falls, gunshot wounds, and sports accidents.
  
  
  OBJECTIVE
  To report signs, symptoms, clinical presentation, diagnostic modalities, acute management, and treatment of an acute spinal cord injury.
  
  
  METHODS
  A case of traumatic cervical spine injury that was not immediately apparent upon presentation is reported. Diagnostic confirmation was possible after obtaining magnetic resonance imaging and after the sedative effects of medications resolved, allowing for a better physical examination.
  
  
  CONCLUSIONS
  Neurogenic shock should be considered in patients with hypotension of unknown or unclear etiology. A ground-level fall is sufficient to cause traumatic spinal cord injury in elderly patients, and a cervical spine computed tomography scan without clear fracture does not exclude this pathology.
authors.affiliation: Residency Program, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7594, USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Gawor
authors.forename: Kevin
authors.initials: K
authors.lastname: Biese
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Platts-Mills
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae; D016292:Procedural Sedation / Q000009:adverse effects*; D057210:Delayed Diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012774:Shock, Traumatic / Q000209:etiology; D013119:Spinal Cord Injuries / Q000175:diagnosis*