(Kiosk 3) Case Report: Progression of Peripheral Neuropathy Masking a Cervical Cord Compression

Case Diagnosis: Severe C7-T1 spinal cord compression (SCC)

Case Description or Program Description: A 74-year-old male with a history of C2-C7 cervical cord decompression /fusion, lumbar laminectomy, and Diabetes Mellitus type 2 (DM2) presenting with progressive lower extremity weakness, postural instability, and imbalance for 1 year, initially associated to peripheral neuropathy (PN). In 3 months, symptoms progressed including sphincter loss, erectile dysfunction, ambulation problems, worsening of lower extremity weakness, and sensation. The patient was referred for evaluation of suspected PN progression, despite a prior electrodiagnostic study (EDX) negative for PN.

Setting: Tertiary care.

Assessment/Results: Examination showed slow, unsteady, wide-based gait, decreased sensation in bilateral lower extremities without a specific dermatome distribution, decreased strength in all extremities, +2 deep tendon reflex (DTR), and no signs of cerebellar or corticospinal dysfunction. Repeat EDX with evidence of generalized demyelinating axonal type neuropathy. On follow-up 1 month after the initial visit, patient was unable to ambulate. Cervical MRI showed severe C7-T1 cord compression with myelopathic changes. Prior Brain MRI negative. Patient was consulted to Neurosurgery service for evaluation.

Discussion (relevance): Causality between SCC and polyneuropathy has not been identified yet, however, spinal cord compression symptoms can be mistaken for the progression of PN, specifically in an older generation with a history of DM2. Polyneuropathy can be induced by spinal canal stenosis; however, the mechanism of this process is not clear. The key factors to suspected cervical cord compression, in this case, were a rapid progression of symptoms, the presence of DTRs (+2), and sphincter loss.

Conclusions: Clinical suspicion for SCC should be raised in patients presenting acute symptoms similar to those seen in PN. Physical examination is essential in the differentiation of these pathologies. Once symptoms are identified, imaging and EDX evaluation are recommended to prevent delays in treatment. There are cases reported of patients with PN and SCC with symptoms improvement after surgical decompression.