An unusual cause of progressive quadriparesis

Upreti,; Ms, Sridhar; Dhull, Pawan; A, Sen

doi:10.4103/2230-8210.119555

Cited by 3 publications

(4 citation statements)

References 3 publications

(6 reference statements)

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“…In extradural lesions usually symptoms are progressive as the size of the lesion increases. (3,4) Elsberg U phenomenon is the progressive quadriparesis with sequential involvement of ipsilateral upper limb, ipsilateral lower limb followed by contralateral lower limb and contralateral upper limb, often described as U-shaped or clockwise involvement of limbs. Elseberg U phenomenon is commonly seen in cervical myelopathy due to cervical extradural lesions or in Foramen magnum pathology and very rarely due to extradural metastasis from follicular carcinoma thyroid.…”

Section: Discussionmentioning

confidence: 99%

“…Elseberg U phenomenon is commonly seen in cervical myelopathy due to cervical extradural lesions or in Foramen magnum pathology and very rarely due to extradural metastasis from follicular carcinoma thyroid. (3,5,6,7) MRI spine is the investigation of choice for spinal tumours. MRI can help in differentiating the intramedullary tumours from extramedullary and extradural tumours.…”

Section: Discussionmentioning

confidence: 99%

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Cervical extradural metastasis from follicular carcinoma thyroid after 14 years post-thyroidectomy with Elsberg phenomenon

Pettakandy¹,

Cholakkal²,

Soren³

et al. 2020

roneuro

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Background. Follicular carcinoma thyroid usually metastasises to bone. Common sites of bone metastasis include skull and spine. Spinal metastasis are more common in the cervical region followed by dorsolumbar spine. Cervical extradural lesions present with progressive quadriparesis, sensory loss, dysautonomia, and respiratory distress. Typical Elsberg phenomenon in a cervical extradural lesion is rare. Elsberg phenomenon involves the involvement of ipsilateral upper limb, ipsilateral lower limb followed by contralateral lower limb and contralateral upper limb. Case presentation. We are reporting a case of 47-year-old lady presented with progressive quadriparesis of 1-month duration. Her weakness started in left upper limb followed by left lower limb, right lower limb and right upper limb weakness. She also had sensory loss below the level of C7. She had undergone near-total thyroidectomy for solitary thyroid nodule 14 years back and was on thyroid supplementation since then. Histopathology at that time was reported as follicular adenoma with Hashimoto thyroiditis. Her right upper limb power was grade 4- Left upper limb grade 1 right lower limb Grade 3, left lower limb grade 2 with hypertonia of both upper and lower limbs. She was evaluated with MRI Spine which showed a dumb bell-shaped extramedullary lesion involving the C5-C6 vertebra with significant cord compression and encasement of the left vertebral artery. USG neck showed left supraclavicular lymph node enlargement and small residual thyroid tissue in the left side of the thyroid. USG guided FNAC from the thyroid tissue and neck nodes were inconclusive. The patient underwent C4 and C5 laminectomy and subtotal excision from the cervical lesion. Histopathology was reported as metastasis from follicular carcinoma thyroid. Postoperatively patient limb power improved to grade 3 left upper and lower limbs and was discharged and later referred for radioiodine ablation Conclusion. Cervical extradural metastasis from follicular carcinoma thyroid can present with Elsberg syndrome even without any neck swelling even after decades of post thyroidectomy status for a benign aetiology. Laminectomy and decompression may lead to clinical improvement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cervical extradural metastasis from follicular carcinoma thyroid after 14 years post-thyroidectomy with Elsberg phenomenon

Pettakandy¹,

Cholakkal²,

Soren³

et al. 2020

roneuro

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“…[ 8 ] Surgical options are primarily posterolateral decompression and occipito-cervical fusion. [ 2 6 8 ] Transoral decompression and fixation remain an option, but the extreme bony erosion might make it technically non-feasible. [ 9 ]…”

Section: Discussionmentioning

confidence: 99%

“…Even if there is metastasis to the atlantoaxial spine, these patients present with bony pains or pathological fractures. [ 6 ] Presentation with cervical compressive myelopathy due to a metastatic atlantoaxial spine tumor is not very common. We report a case of prostate malignancy presenting as spastic quadriparesis as the first clinical symptom.…”

Section: Introductionmentioning

confidence: 99%

Spastic quadriparesis due to pathological fracture of odontoid secondary to carcinoma prostate: A rare presentation

Gill

Swamy

Maheshwari

et al. 2017

J Craniovert Jun Spine

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Prostate carcinoma presenting as symptomatic metastases to atlantoaxial spine is extremely rare. Spastic quadriparesis due to pathological fracture of odontoid as the only initial manifestation without symptoms of primary malignancy is rarer still. We report a 64-year-old male who presented with progressive spastic quadriparesis along with urinary retention of 3 weeks duration. Computed tomography and magnetic resonance imaging cervical spine and craniovertebral junction showed type III pathological fracture of odontoid with anterior translation of C1 with spinal cord compression. Biopsy from an enlarged prostate showed adenocarcinoma of prostate. The patient was managed conservatively from neurological aspect as he refused for any surgical intervention.

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Isolated Spinal Metastasis with Spinal Cord Compression Leads to a Diagnosis of a Follicular Thyroid Carcinoma

Toshkezi¹,

Galgano²,

Libohova³

et al. 2015

Cureus

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Introduction: Thyroid carcinoma initially presents with clinical symptoms due to metastatic lesions in less than 5% of cases. Spinal cord compression from an epidural metastatic lesion as a first symptom is extremely rare. One would expect such a presentation to occur much later in the course of the disease.Methods: We are presenting a case report of a follicular thyroid carcinoma that presented with spinal cord compression from a thoracic epidural metastatic lesion in a previously healthy 55-year-old male. A single metastasis of follicular thyroid carcinoma presenting with posterior spinal cord compression is rare. In this particular case, our management included a mid-thoracic laminectomy, followed by resection of the epidural lesion. Once the surgical pathology confirmed the diagnosis of a follicular thyroid carcinoma, the general surgery team performed a near total thyroidectomy, after which he received radioactive iodine therapy. The patient is symptom-free at his three-year follow-up.Conclusion: Initial presentation of follicular thyroid carcinoma with symptomatic thoracic myelopathy from an epidural metastasis is very uncommon. An early diagnosis and prompt surgical intervention provided an excellent outcome.

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An unusual cause of progressive quadriparesis

Cited by 3 publications

References 3 publications

Cervical extradural metastasis from follicular carcinoma thyroid after 14 years post-thyroidectomy with Elsberg phenomenon

Cervical extradural metastasis from follicular carcinoma thyroid after 14 years post-thyroidectomy with Elsberg phenomenon

Spastic quadriparesis due to pathological fracture of odontoid secondary to carcinoma prostate: A rare presentation

Isolated Spinal Metastasis with Spinal Cord Compression Leads to a Diagnosis of a Follicular Thyroid Carcinoma

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