Picture quiz Trauma to neck after a fall
A 72 year old woman attended the emergency department with a one day history of a fall after drinking two bottles of wine. She was found by her neighbour in a confused state and an ambulance was called. She complained of severe neck pain and an occipital headache associated with nausea. On examination, her Glasgow coma scale score was 15/15 and neurologically she was intact. There was some tenderness in the neck, but no bruising or deformity, and no restriction of movement was found. A diagnosis of a soft tissue injury was made and she was discharged home with analgesia and head injury advice, under the supervision of her son.
The patient presented again to the emergency department four weeks later with ongoing pain unrelieved by simple analgesia. The patient stated that it “felt like her head was falling off.” There were no new findings on examination. X ray imaging