This report describes a unique presentation of stridor in an elderly patient who presented to the emergency department (ED) with neck and back pain after a fall down a flight of stairs. The patient had no airway issues on initial evaluation in the resuscitation room, but developed stridor and respiratory distress after returning from imaging. The unexpected stridor and respiratory distress were alleviated with basic airway maneuvers that included airway repositioning and a breathing treatment. Cervical computed tomography (CT) showed a cervical fracture and a retropharyngeal hematoma, which was responsible for the partial obstruction of this patient’s upper airway leading to delayed stridor. Following management of the respiratory distress, the patient was diagnosed with and treated for central cord syndrome. The key takeaway from this case is that there should be a low level of suspicion for impending upper airway compromise in elderly patients presenting to the ED with a cervical spine injury.TopicsStridor, retropharyngeal hematoma, cervical spine fracture, central cord syndrome.