What is the most common symptom associated with cervical spinal cord injury?

Most Common Symptom Associated with Cervical Spinal Cord Injury

Headache is the most common symptom associated with cervical spinal cord injury. 1

Pathophysiology and Presentation

Cervical spinal cord injury represents a significant medical condition with potentially devastating consequences for patients. When examining the clinical presentation of these injuries, several key symptoms emerge:

• Headache: Identified as the most common symptom reported in adults and children following cervical injury 1
• Different types of headaches can occur following head and neck injury, often with occipital/suboccipital location when associated with cervical strain 1
• Pre-existing headache conditions may be worsened following cervical injury 1

Additional Common Symptoms

While headache is the primary symptom, other common manifestations include:

• Neck pain and stiffness: Particularly common in cervical strain associated with spinal cord injury 1
• Upper extremity weakness: Often presents as brachial diparesis in lower cervical injuries 2
• Sensory dysfunction: Including paresthesia in upper extremities 1
• Motor deficits: Particularly affecting hand dexterity and gait stability in cervical spondylotic myelopathy 3

Neurological Manifestations

The severity and location of cervical spinal cord injury determine the neurological presentation:

• Complete spinal cord injury with transverse myelopathy results in total loss of spinal function below the lesion level 4
• Lower cervical injuries often present with paraplegia and partial impairment of upper limb movement 2
• Patients may experience decreased hand dexterity and gait instability 3

Risk Factors and Epidemiology

Understanding the epidemiology helps contextualize the symptom presentation:

• Cervical spine injury complicates 2-12% of blunt polytrauma cases 1
• 55% of all spinal cord injuries are cervical 1
• Severe head injury increases the relative risk of cervical spine injury by approximately 8.5 times 1
• Children under 8 years have unique vulnerability to upper cervical spine injuries due to incomplete ossification, unfused synchondroses, ligamentous laxity, and large head-to-body ratio 1

Clinical Implications

The high prevalence of headache as the primary symptom has important clinical implications:

• Headache may be the earliest indicator of cervical injury, making it a crucial assessment point
• Missed or delayed diagnosis of cervical spine injury may produce 10 times higher rates of secondary neurological injury 1
• Up to 67% of patients with missed cervical fractures suffer neurological deterioration 1

Diagnostic Considerations

When evaluating patients with suspected cervical spinal cord injury:

• Assess for headache characteristics, location, and severity using validated scales 1
• Evaluate for associated symptoms including neck pain, motor weakness, and sensory changes 1
• Consider imaging in patients with persistent headache, especially with occipital/suboccipital location 5
• Be aware that some patients may have spinal cord injury without radiological abnormality (SCIWORA), particularly children 1

The recognition of headache as the primary symptom of cervical spinal cord injury underscores the importance of thorough neurological assessment in patients presenting with new or changed headache patterns following trauma.