A 10-year-old girl presents to the pediatric emergency department (ED) with acute onset of sharp neck pain and torticollis that began on awakening the morning of presentation. She has had shoulder pain for the past 3 days and in addition developed pain in her neck the morning of presentation. This morning she developed numbness in her legs and inability to walk. She has no associated headache, dizziness, fever, or urinary or bowel incontinence.

She had a recent ED visit for flank pain due to constipation treated with polyethylene glycol 9 days earlier. Her medical history includes asthma and eczema. She is fully immunized. She has had a 12-lb (5.4-kg) weight loss in the previous 7 weeks.

Her initial vital signs are as follows: temperature, 98.8°F (37.1°C); pulse, 104 beats/min; blood pressure, 138/91 mm Hg; respiratory rate, 20 breaths/min; and oxygen saturation, 100% on room air. She is generally well-appearing but...

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