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Short Case Presentation

Short Case Presentation. Dr Shonali Valsangkar Assistant Professor Neurosurgery Department. Positive History. 42 Yrs old right handed male, Clark by occupation Sudden onset neck pain radiating to the lateral aspect of left arm following lifting weight( One and half month back)

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Short Case Presentation

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  1. Short Case Presentation Dr ShonaliValsangkar Assistant Professor Neurosurgery Department

  2. Positive History • 42 Yrs old right handed male, Clark by occupation • Sudden onset neck pain radiating to the lateral aspect of left arm following lifting weight( One and half month back) • Tingling numbness followed by weakness in the left UL one and half month back • Stiffness in left LL causing loss of balance while walking since 1 month • Numbness and paresthesia in right LL (ascending type) since 20 days • Altered hot cold sensation on the right LL since 20 days • Tingling and numbness in right UL since 20 days • Constipation since 20 days • Difficulty in passing urine since 20 days

  3. Extent of Lesion Vertical Radiculopathy in the C4 C5,C5 C6 division with sensory loss in the same • Cranial nerves – normal • Neck muscle power – normal • SCM – normal • No Horners syndrome • Weakness in left UL

  4. Horizontal extent

  5. Positive Signs • Muscle bulk normal – no wasting/fasciculations • Tone – UL normal , LL hypertonia • Power- right left • Deltoid 5/5 4/5 • Biceps 5/5 4/5 • Triceps 5/5 4/5 • Wrist f/e 5/5 5/5 • P/G Strong Strong • LL 5/5 5/5 • SCM Rhomboids and trapezius were strong bilaterally

  6. Reflexes • DTR- right left • Biceps/brachio 3+ 3+ • Triceps 3+ 3+ • Wartenberg’s + + • Hoffman sign + + • LL 3+ 3+ • Plantars Extensor Extensor • Pectoralis 3+ 3+ • Deltoid reflex 3 + 3+ • Superficial reflexes - absent

  7. Sensations – • Pain – decreased in C4 C5 dermatome on the left side • Paresthesias on the right side below C6 • Touch – Decreased in C4 C5 dermatome on the left side • Hot and cold – impaired hot sensation on right side below C6 • No sacral sparing

  8. JPS – normal • vibration – normal

  9. Summary and Diagnosis 1 . Sudden onset left C4 C5 radiculopathy 2. Spastic parapresis • Unilateral spinothalamic tracts • Bowel bladder involvement ( Spastic Neurogenic bladder) Diagnosis- C4 C5 Disc Prolapse

  10. Differential Diagnosis • 1. Extradural tumor • 2. Intradural extra medullary tumor

  11. How to reach diagnosis • History— • Sudden onset following insult • Progression

  12. Lateral Xray

  13. MRI

  14. MRI

  15. Final diagnosis • Anterolateral Compressive extradural lesion C4C5,C5C6 Radiculomyelopathy – Disc Prolapse and lateral recess stenosis

  16. Thank You

  17. Trapezeus- C234XI • Rhomboid C45 • Serratus anterior C567 • Pectorali C5 to T1- brisk lesion C2C3 or C3 C4 • XI – C1 to C5 innervates – SCM and upper portion of trapezius

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