Film Quiz: Sudden Onset Acute Neck Pain with Hemiparesis - Pearls and Pitfalls

A 64-year-old woman presented to the emergency department complaining of sudden onset of right side neck pain radiating to the right scapula and right sided weakness. There was no history of headache or similar episode in the past. No past history of diabetes mellitus, hypertension or cardiac disease was present. On physical examination, there was loss of power in right upper and lower limbs (right upper limb: 2/5 and right lower limb: 1/5). There was no loss of power in the left limb. Patient's blood pressure was 124/82 mmHg, heart rate of 90/minute and oxygen saturation was 99% on room air. There was no difference of blood pressure in the arms. Glasgow coma scale (GCS) was 15 and initial laboratory investigations were within normal limits. A 12-lead ECG showed no acute changes. Urgent non-enhanced computed tomography (CT) of the brain followed by a CT angiogram of neck and circle of Willis was performed as patient complained of severe neck pain. After discussion with the neurosurgeons, the patient underwent a Magnetic Resonance Imaging (MRI) of the whole spine.