Cervical disc prolapse with cord compression presenting with choreoathetosis and dystonia

Abstract

Movement disorders from spinal cord disease are rare and can be caused by underlying neoplasm, inflammation, demyelination, or trauma. [1][2][3][4] Cervical radiculopathy caused by disc herniation or cervical spondylosis is common and important to recognize because it may improve after decompression surgery. We describe a patient with cervical disc prolapse presenting with choreoathetosis and dystonia.Case report. A previously well 62-year-old Chinese woman presented with involuntary movements of her upper extremities of 3-month duration. She observed that her fingers would wriggle on their own and her arms would move involuntarily. These movements were much worse during action than rest. She reported no premonition or any urge before these movements, and did not feel any relief afterwards. The movements were aggravated by stress, agitation, or anxiety, and were relieved by rest and sleep. She also noted that her fingers (particularly the index and middle fingers) would intermittently go into spasms, with involuntary flexion at the metacarpal-phalangeal joints; these spasms were relieved by putting her fingers in contact with other body parts. In addition, she had concurrent "tingling" sensations of the fingertips of both hands (right more severely affected). There were no abnormal movements involving the oro-facial-buccal region or lower extremities. She had no urinary or bowel complaints. There was no history of exposure to neuroleptic medications, severe head trauma, or dementia. No relatives had similar problems. She was initially evaluated by an orthopaedic surgeon who suspected underlying carpal tunnel syndrome (CTS). This was confirmed on the nerve conduction test, which revealed a mild to moderately severe right CTS. However, she was subsequently referred to the Movement Disorders Clinic for further evaluation.Neurologic examination demonstrated dystonic posturing of her fingers when upper arms were outstretched and in wingbeating position. Her index and middle fingers were flexed at the metacarpal-phalangeal joints and proximal inter-phalangeal joints, together with mild pronation at the radio-ulnar joints. Stereotypic finger movements were observed when she tried using her hands. On walking, choreoathetoid movements in both of her upper extremities were present. Power in all of her extremities was full. There was increased tone in both her lower extremities, generalized hyper-reflexia in her four extremities with no clonus. Her jaw jerk was not brisk. Plantar response was flexor bilaterally. There was no loss of sensation to pinprick, light touch, or presence of a sensory level, and proprioception and vibration sense were intact. There were no signs of cerebellar dysfunction and Romberg test was negative. She had no clinical evidence of dementia and no Kayser-Fleischer ring on ophthalmic examination.MRI of cervical spine revealed severe cord compression at C3-C4 level by a prolapsed disc ( figure, A and B). Brain MRI scan did not show any abnormalities. Transcranial magnetic stimulation study demonstrat...

Myelopathy as a complication of cervical dystonia

“…There is a case report of cervical disk prolapse with cord compression presenting with dystonia. 7 In our case, the localization of degenerative changes and the presentation of the myelopathy more than 10 years after the diagnosis of cervical dystonia argue against this hypothesis.…”

Cervical myelopathy in athetoid and dystonic cerebral palsy: retrospective study and literature review

“…The presence and the evolution of preoperative vesicospincteric problems were rarely reported which we think are of great importance in disability [2,9,16,19,22,23]. Of the six patients who newly developed or had a worsening of sphincteric control, only three recovered their previous function.…”

“…Surgical treatment always requires spinal cord decompression by anterior approach (corporectomy and discectomy) or by posterior approach (laminectomy and laminoplasty) [2,7,9,13,17,19,22,23]. No isolated cervical laminectomy should ever be performed alone [2,11,14,17,18].…”

Spinal myoclonus: a rare presentation of cervical myelopathy

“…Thus, a contrast-enhanced MRI of the whole neuro-axis is essential to identify the segmental lesion responsible for the myoclonus which should be later supplemented with additional investigations to exclude a systemic disorder (eg, vitamin B 12 deficiency and HIV) 8. Several reports have also linked spinal myoclonus with postoperative changes associated with laminectomies26 but no clear correlation has been demonstrated between degenerative spinal disease and movement disorders, that included myoclonus,7 21 27dystonia28–30 and choreoathetosis 31. Of important note however is that despite these underlying pathologies, only a small fraction presents clinically with myoclonal disorders, with the majority presenting simply as cervical myelopathy, suggesting that the type of lesion itself is not the culprit, but instead the underlying involvement of the interneuronal fibres (see below) 8…”