Three patients presented with hand wasting and weakness secondary to mid-cervical spinal cord compression. This was due to cervical spondylosis in two patients and a meningioma in one case. This phenomenon is probably similar to that seen with foramen magnum lesions and may be due to spinal cord ischemia distal to the compression, secondary to venous stasis. RESUME: Atrophie de la main due a une compression medullaire localisee a la region cervicale moyenne. Trois patients ont consulte pour de l'atrophie et de la faiblesse a la main secondaires a une compression medullaire a la region cervicale moyenne. Cette symptomatologie etait due a une spondylose cervicale chez deux patients et a un meningiome dans l'autre cas. Ce phenomene est probablement semblable a celui que Ton rencontre dans les lesions du trou occipital et peut etre cause par I'ischemie de la moelle epiniere, secondaire a la stase veineuse, en aval de la compression.Can. J. Neurol. Sci. 1987; 14:309-311 Hand wasting has not been commonly reported with lesions of the middle cervical spinal cord 1 although it is a well known feature of compressive lesions at the foramen magnum.2 " 4 We describe three patients with hand wasting due to mid-cervical cord lesions and discuss the significance of this clinical finding.CASE HISTORIES Patient 1: This 41-year-old woman presented with a sixteen month history of wasting and weakness of her left hand which she first noted after a minor hand injury. She had minimal pain of the left side of her neck and left upper arm. This was not characteristic of radicular pain. On physical examination, movement of the neck was normal. There was marked wasting and weakness of all the intrinsic muscles in the left hand. There was slight wasting and weakness of the left forearm flexors and extensors. The sensory exam and remainder of the neurological examination was normal. The electrophysiological studies on the left revealed a slight reduction of the fifth digit sensory nerve action potential and active denervation in both the abductor pollicus brevis and the first dorsal interosseus. The motor conduction studies were normal in the median and ulnar nerves. X-Rays of the cervical intervertebral foramina were normal. The transverse processes of C7 were prominent bilaterally. A cervical myelogram revealed a large anterior extradural defect at C5-6 (Figure 1). She had an anterior cervical discectomy and fusion at C5-6. Post-operatively she had complete resolution of her preoperative pain and subjectively found that the function of the left hand had improved although no change in strength was noted. Repeat EMG seven months later showed improvement with less denervation in the thenar muscles. At follow-up four years later there was no evidence of any improvement in strength. Patient 2:This 44-year-old woman had an eight year history of pain extending from the right elbow to the wrist. For six years she had mild progressive weakness of the right hand and forearm muscles. There was no neck pain. Examination showed slight was...
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