49-year-old male with no significant past medical history presented to the ED for progressive neck pain and bilateral upper extremity weakness in a cape-like distribution for 6 months, worsening over the past week. Notably, the patient was in a motorcycle accident in a foreign country 6 months earlier, when he was struck from behind and ejected from his vehicle, landing on his left side. He states that he lost consciousness for 3 minutes at the time of injury, and he received MR imaging of his cervical spine at that time that was unremarkable for acute pathology. He was discharged to home and received no further neurological follow-up following the injury.