The Real-World Boards: Question #36
As alcohol levels fall, new symptoms may appear
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A 46-year-old man who drinks large amounts of alcohol daily and who has a history of MRSA bacteremia presents to the ED after falling down stairs while intoxicated. Ethanol level is 80 mg/dL. He is evaluated by the trauma team and “cleared” after CT and exam show no fractures or hemorrhage. He is agitated and is considered “too much for the floor,” and is admitted to the ICU on a dexmedetomidine infusion and symptom-triggered therapy for potential alcohol withdrawal delirium.
Two hours later, he complains of severe neck pain. On exam, vitals are normal (BP 100/55, pulse 90, respirations 18/min, afebrile), but he has diminished (4/5) strength in the deltoids, biceps, and handgrip bilaterally. Plantar flexion and hip flexion are both 5/5 bilaterally.
Cervical spine CT shows degenerative cervical spondylosis without fracture. He is placed in a cervical immobilization collar. An MRI of the cervical spine is pending. Neurosurgery has been consulted.
