Traumatic Cervical Myelopathy Masked by Alcohol Intoxication and Diagnostic Anchoring

Acute alcohol intoxication often masks traumatic injuries, leading to diagnostic anchoring and delayed management. We report the case of a 61-year-old male presenting with sudden-onset quadriplegia. Initial clinical suspicion favoured a cerebrovascular accident or Guillain-Barré syndrome due to the patient's amnesia about a fall and the presence of new-onset atrial fibrillation. A significant diagnostic delay occurred until collateral history from peers revealed a "faceplant" injury, and the retrospective identification of a cutaneous imprint from the patient's eyeglasses confirmed a hyperextension mechanism. Despite an initial report of a fracture, subsequent imaging confirmed an isolated, severe cord contusion from C3 to C6 without associated bony disruption. This report highlights the importance of the fundamentals of the diagnostic process, including comprehensive history gathering and a thorough bedside examination.