When first evaluating a patient and creating a differential diagnosis, if t’s not on your radar it may likely get missed.
A 47 yr old female presents to the emergency department via private vehicle from home for evaluation of headache and neck pain. She reports that she was the restrained driver involved in a minor two car motor vehicle collision yesterday, in which she struck the rear of the vehicle in front of her at moderate rate of speed resulting in deployment of her airbag.
She denies loss of consciousness and was relatively asymptomatic at the time of the accident. She self-extricated herself from her vehicle and was ambulatory at the scene. When emergency medical services arrived she claimed she was uninjured and declined medical transport. Overnight, she developed a left sided temporal headache and left sided neck pain.
Upon presentation her vital signs are normal and she is ambulatory with a steady gait. Physical exam revealed no midline cervical spine tenderness. She complained of reproducible pain to the left side of the neck with range of motion but had no tenderness and no visible abrasion, ecchymosis or palpable hematoma. She denied facial, oral or dental injury and had a normal visual acuity exam but something just wasn’t quite right.
1. What are your initial thoughts?
2. What’s wrong with this picture?
3. What should you be considering on your differential diagnosis?
4. What’s your next step?