What diagnostic is a priority for a 14-year-old with Down syndrome showing abnormal gait and urinary incontinence?

In the case of a 14-year-old with Down syndrome presenting with an abnormal gait and urinary incontinence, the priority diagnostic approach focuses on the potential for cervical spine issues, particularly atlantoaxial instability. Children with Down syndrome frequently face musculoskeletal complications, including instability in the cervical spine due to ligamentous laxity.

Given the symptoms of abnormal gait and urinary incontinence, there is a significant concern for spinal cord compression or neurological impairment resulting from cervical spine issues. Radiographs of the cervical spine can provide immediate insights into any possible misalignment or instability that could be affecting the spinal cord and leading to these neurological symptoms. Thus, identifying any structural concerns swiftly is essential to guide further treatment and prevent potential complications.

While a complete neurologic exam is important for gathering detailed information about neurological function, it would be most effective in conjunction with imaging studies, particularly when there is a suspicion of structural abnormalities. In this scenario, the urgency of determining the cause of the symptoms directly relates to the cervical spine. Other diagnostics, such as lumbar spine MRI or urinalysis, may also be useful but are not prioritized over ruling out cervical spine issues given the present symptoms.