What is the appropriate management for a 24-year-old with decreased sensation on the left side of the neck without pain or motor function deficits?

Management of Isolated Left-Sided Neck Numbness in a 24-Year-Old

For a 24-year-old with isolated unilateral neck numbness without pain or motor deficits, initial imaging is not indicated—begin with conservative management and clinical observation for 4-6 weeks, as this presentation lacks the red flags that would warrant immediate MRI. 1

Why Imaging Is Not Initially Required

Your patient's presentation differs fundamentally from typical cervical radiculopathy, which requires neck pain radiating into the arm with dermatomal sensory or motor changes in the upper extremity—not isolated neck numbness. 1 Pure sensory symptoms confined to the neck itself suggest involvement of superficial cervical cutaneous nerves (C2-C3 distribution) rather than nerve root compression. 1

The American College of Radiology explicitly states that imaging for acute neck symptoms without red flags rarely alters initial management, particularly since degenerative changes are common in asymptomatic individuals over age 30 and correlate poorly with symptoms. 1, 2 At age 24, your patient is even less likely to have clinically significant degenerative findings.

Red Flags That Are Absent (But Must Be Monitored)

Your patient currently has none of the following concerning features that would mandate urgent evaluation:

• Progressive motor weakness or neurological deficits 3, 1
• Bilateral symptoms suggesting myelopathy 3, 1
• New bladder or bowel dysfunction 3, 1
• Loss of perineal sensation 3, 1
• Symptoms affecting both upper and lower extremities 3, 1
• Constitutional symptoms such as fever, weight loss, or night sweats 1
• History of trauma 4

Initial Management Strategy

Reassure the patient that most acute neck symptoms, even with radicular features, resolve spontaneously or with conservative treatment in 75-90% of cases. 1 For isolated sensory changes:

• Observe for spontaneous resolution over 4-6 weeks 1, 4
• Consider physical therapy targeting cervical proprioception and sensorimotor control if symptoms persist, as cervical proprioceptive impairment can cause altered sensation 5
• Avoid NSAIDs unless pain develops, since the patient is currently pain-free 4

When to Escalate to Imaging

MRI of the cervical spine without contrast becomes appropriate only if: 1, 3

• Symptoms persist beyond 6 weeks despite conservative management 1
• New neurological symptoms develop, including motor weakness, upper extremity radiation, or bilateral symptoms 1, 3
• Any red flags emerge during follow-up 1

MRI is the most sensitive modality for detecting soft tissue abnormalities including disc herniation and nerve root compression, but should be reserved for cases where findings would change management. 1

Differential Considerations Beyond Radiculopathy

Since this doesn't fit classic radiculopathy, consider:

• Peripheral nerve entrapment or irritation causing isolated sensory changes without dermatomal radiation 1
• Cervical plexopathy presenting with atypical sensory distributions that don't follow classic dermatomal patterns 1
• Cervical proprioceptive dysfunction from muscle tension or minor cervical pathology, which can alter sensation without structural nerve compression 5, 6

Critical Pitfalls to Avoid

Do not immediately attribute isolated neck numbness to cervical radiculopathy without considering other causes—the classic presentation includes arm pain and dermatomal sensory/motor changes. 1 Ordering MRI in the acute phase (<6 weeks) without red flags leads to identification of incidental degenerative findings that don't correlate with symptoms and may drive unnecessary interventions. 1, 2

Do not overlook non-spinal causes such as peripheral nerve involvement, which may require different diagnostic approaches. 1 If symptoms follow a non-dermatomal distribution or involve only superficial neck sensation, this supports a peripheral rather than radicular etiology.

Follow-Up Timeline

Reassess at 4-6 weeks to determine if symptoms are resolving, stable, or progressing. 1 Document any new symptoms that develop, particularly motor changes, pain radiation into the arm, or bilateral involvement, as these would change the management algorithm and warrant MRI evaluation. 1, 3