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SUMMARY The acute onset of symptoms of severe cervical radiculo-myelopathy in four patients with athetoid-dystonic cerebral palsy is reported. Neurological and radiological examination showed that the spondylotic changes of the cervical spine were responsible for new neurological deficits leading to the patients being bedridden. Dystonic-athetoid neck movements may cause excessive axial neck rotation as well as flexion and extension movements of the spine. These repetitive exaggerated movements may result in early degenerative changes of the vertebrae which may enhance the radiculo-myelopathy. The four patients were treated with an anterior discectomy with interbody fusion. They were bedridden pre-operatively but all have since been able to walk with or without a cane. It is concluded that early anterior decompression with interbody fusion is a treatment of choice for cervical spondylotic radiculo-myelopathy in association with athetoid cerebral palsy.Trauma as a cause of cervical spondylosis, with or without neurological deficits, has often been proposed. Reports allude to a causal relationship between movement disorders of the neck and the development of cervical spondylosis, but this relationship has not been clearly established. We have observed the acute onset of cervical radiculomyelopathy in four patients with athetoid-dystonic cerebral palsy. After myelography, all patients were treated surgically. Cse reportsCase 1 A 41-year-old woman with athetoid movements since the age of 10 years had undergone a complicated delivery with umbilical cord prolapse, and did not walk alone until the age of 4 years. When aged 40 years she first noted neck and shoulder pain with a numb feeling in the ulnar aspect of the hands. One month later she suddenly developed arm and shoulder pain bilaterally with weakness and tonic spasm of the legs. Since then she had been bedridden. She was referred to us 3 weeks later. She denied urinary or faecal incontinence throughout the course of her illness. Address Neurological examination revealed generalised athetoid-dystonic movements. No muscle atrophy was noted but she was barely able to extend her arms or to raise her legs from the bed. The right limbs were weaker than the left. She could not stand by herself. There was hypoalgesia in the distribution of C7-C8 bilaterally. Deep tendon reflexes were hyperactive throughout, and bilateral extensor plantar responses were elicited with occasional extensor spasms.Cervical spine radiographs showed a narrow canal (narrowest antero-posterior diameter, 11X5 mm at C3-C4 level) and narrowed disc space at the level of C3-C4. Myelography confirmed a disc protrusion with a partial block at the level of C3-C4. She underwent anterior discectomy with the removal of osteophytes, under the operating microscope. No interbody fusion was performed. Athetoid-dystonic movements were controlled with 2-25 g of levodopa daily. She regained strength in the arms and legs and stood at the 14th postoperative day. Two months after operation her neurological status...

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Paramedian pontine infarcts, which are usually due to thrombosis of perforating arteries, presented with a faciobrachial dominant hemiparesis with dysarthria, somatosensory disturbance, and horizontal gaze abnormalities. The favorable outcome may be related to the level of the pontine lesion, which influences the effect on the corticospinal tract.