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Introduction

This 40 year old woman was the intoxicated driver of a car which hit a tree at 80 km/hr.   Impact was head on, and both driver and passenger were wearing seatbelts at the time of impact.  The passenger was taken to the local hospital where she had abdominal injuries.  The driver was seen at the local hospital and transfered to your trauma centre. 

When she arrives, she is on a long spine board and a semirigid cervical collar is on.  She is able to turn her head while in the collar, and is somewhat agitated.  She complains of "a little neck pain" and appears to be slurring her words. 

CT scan of her head is normal, and her blood alcohol level is elevated.  Neurologic examination reveals mild weakness of elbow flexion and extension on the left side, associated with decreased sensitivity to two-point-discrimination over the left lateral forearm.

Radiographs are shown below.

Radiographs of the C-spine


cs_ap1.jpg (19989 bytes)  cs_lat1.jpg (18352 bytes)  cs_ct.jpg (15021 bytes)  

What is the diagnosis ?

Does it explain the neurologic findings?

How would you treat this patient:
A: In the trauma room ?
B: Definitively ?

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