Encephalic Symptoms Leading to Diagnosis of Cervical Myelopathy

Abstract

Background Dizziness is a common symptom with a plethora of etiologies. Diplopia can implicate severe neurologic disease, including cerebral lesions. When patients are referred to physical therapy with a diagnosis of dizziness, thorough clinical reasoning and medical screening are of utmost importance. Case Presentation A 55-year-old woman presented to a physical therapy clinic with primary symptoms of dizziness and diplopia that were reproduced with active and sustained cervical rotation. Additional history included dysarthria and dysphasia. Sensation and upper and lower motor neuron tests were unremarkable. Horizontal and vertical corrective saccades were observed. Suspicion of cervical arterial dysfunction was cleared by her neurologist. Primary symptoms were reproduced with neurodynamic testing, prompting concern for central pathology and referral back to the neurologist. Magnetic resonance imaging revealed cervical cord compression, subsequently treated with cervical fusion. Postoperative physical therapy included neurodynamic techniques. Outcome and Follow-Up Primary symptoms resolved without recurrence over 12 months, and Dizziness Handicap Inventory scores improved significantly. Discussion Cervical myelopathy can severely impact function and quality of life. Differential diagnosis, screening, appropriate referral, and communication with other providers are among physical therapists' primary responsibilities and integral contributions to the interprofessional care team. JOSPT Cases 2021;1(2):87–91. doi:10.2519/josptcases.2021.10048