“I am not delusional!” Sensory dysaesthesia secondary to degenerative cervical myelopathy

Abstract

Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction, most classically presenting with a broad-based gait and clumsy hands. Limb sensory loss and paraesthesia are considered common symptoms of DCM. However, we report an unusual case of a patient presenting with prominent and atypical sensory symptoms. The patient repeatedly presented to accident and emergency complaining of her body resembling a wet gel-like substance that she attributed to the use of olive oil moisturising cream. The patient was found to have myelopathic signs on examination and MRI consistent with severe cervical myelopathy. She subsequently underwent successful decompressive anterior cervical discectomy, as recommended by international guidelines. This case serves to remind health professionals of uncommon presentations of common disease and the importance of maintaining a wide initial differential diagnosis.

Optimizing the Application of Surgery for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 10]

“…Kobayashi et al found that DCM patients reported chest tightness 22.9 times more often than non-myelopathic patients, 73 resulting in inclusion as one of the symptoms to be queried in an 8-item questionnaire for DCM screening. Mowforth et al 74 reported a patient with sensory dysesthesia, including facial dysesthesia secondary to DCM with typical gait, dexterity, and sphincter symptoms that were only linked to DCM after 11 visits to the emergency department. 74 Oh et al 75 reported a patient with DCM in which a megacolon only resolved after surgical decompression of the cervical stenosis.…”

“…Mowforth et al 74 reported a patient with sensory dysesthesia, including facial dysesthesia secondary to DCM with typical gait, dexterity, and sphincter symptoms that were only linked to DCM after 11 visits to the emergency department. 74 Oh et al 75 reported a patient with DCM in which a megacolon only resolved after surgical decompression of the cervical stenosis. 75 Houten et al reported a series of 12 DCM patients presenting without upper extremity symptoms 76 that all reported gait difficulty; more than half had objective lower extremity weakness.…”

Outcomes of Degenerative Cervical Myelopathy From The Perspective of Persons Living With the Condition: Findings of a Semistructured Interview Process With Partnered Internet Survey

“…We recently reported on an unusual case of sensory dysesthesia in DCM involving the body but also the face. 39 Our prevailing clinical view was that the facial symptoms represented a psychosomatic overlay but conceptualized that projections of the nucleus-tractus solitarius do project into the cervical spinal cord and altered trigeminal nerve processing was theoretically possible. Additionally, the emerging evidence of structural cerebral re-organization in response to myelopathy 40,41 questions whether there is associated altered central processing.…”

Current provision of myelopathy education in medical schools in the UK: protocol for a national medical student survey

“…18 There is a broad differential for DCM symptoms 19 and poor consensus on what the most common DCM symptoms are. In addition, an increasing number of less well-described symptoms such as dysaesthetic sensory symptoms, 6 chest tightness 20 and headache 21 are being reported. 22 Neurological examination findings include upper motor neuron signs in the upper and lower limbs: spasticity and hyperreflexia in addition to weakness.…”

“…Initially, patients with DCM are commonly seen by primary care, emergency and medical physicians. 6 7 These non-specialist triage points appear key to earlier diagnosis, yet DCM features poorly in medical curricula. 8 This risks non-specialist doctors being poorly equipped to detect DCM.…”