A cervical spine injury can cause headaches, vertigo, dizziness, tinnitus, and rarely unilateral exophthalmos. The relationship between cervical spine injury and reflex sympathetic dystrophy (RSD) is well established to explain the symptoms. Here, we present a patient developing bilateral exophthalmos after a fall with cervical spine injuries. Although unilateral cervicogenic exophthalmos has been suggested in the literature, we describe the first case of bilateral cervicogenic exophthalmos after a cervical spine injury. 

Case Report: 

A 53-year-old man presented after a fall at home. Trauma workup revealed hyperextension injury, anterior longitudinal ligament (ALL) disruption, and cord edema from C3-C6. After admission, the patient had quadriplegia and significant bilateral exophthalmos. He had urgent open reduction and internal fixation (ORIF) of C4-C5 and C5-C6, discectomies, and fusion with the insertion of plates and screws. After the surgery, his exophthalmos improved significantly. Unfortunately, multiple attempts to wean from the ventilator were unsuccessful. The patient's family elected for compassionate extubation and discharge to hospice services per his living will, where he passed away.  

A cervical spine injury is a very rare cause of exophthalmos. Two case reports were found online for unilateral exophthalmos related to spondylosis of the cervical spine, which is thought to be caused by RSD, a chronic condition. Here we describe a patient presenting with significant bilateral exophthalmos secondary to the acute traumatic cervical spine. The patient's bilateral exophthalmos improved significantly after his cervical spine surgery. To the best of our knowledge, ours is among the first few case reports of acute 'traumatic cervicogenic exophthalmos.' Further speculation is that the exophthalmos is probably associated with sympathetic nervous system hyperactivity related to cervical spine injury.