Accidental penetrating cervical cord injury in a young child

A three-year-old child presented to our emergency department with a hemiparesis five days following the accidental laceration of her neck with a piece of glass. The laceration had been thought to be superficial when she was initially evaluated. When seen again three days following the injury because of right-sided weakness, computerized tomography of her head and neck was unrevealing. However, using high resolution magnetic resonance imaging (MRI) we were able to demonstrate a C1-2 cord contusion and an injury tract leading from the surface of the neck to this site. The unusual mechanism of injury and the underlying pathophysiology of this patient's presentation are reviewed. It is important for the emergency physician to be reminded that what appears to be a superficial laceration can sometimes be more serious. MRI should be considered in the evaluation of patients who have suffered penetrating trauma if the potential for spinal cord injury exists and especially when there are signs or symptoms suggesting spinal cord dysfunction.