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901 - A Carotid Conundrum: A Peculiar Case of Cervical Radiculopathy

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

ZS

Zakaria Sheikh, MD

Resident
One Brooklyn Health
Manhattan, New York, United States
AC

Alexander T. Csorba, DO

Resident Physician
One Brooklyn Health
Brooklyn, New York, United States
RD

Rakesh Dara, DO

Resident
One Brooklyn Health
Manhattan, New York, United States

Co-Author(s)

ST

Samuel Thampi, MD

PMR Attending
Kingsbrook Jewish Medical Center
Brooklyn, New York, United States
MA

Mohammad Aalai, MD

PMR Attending
One Brooklyn Health
Brooklyn, New York, United States

Case Diagnosis: Cervical radiculopathy

Case Description: An 88-year old female who presented with chronic left arm pain and sensory abnormalities starting since a past carotid sheath tumor repair. Her pain was described as aching with associated numbness and tingling of distal arm that was ascending over time. Although all fingers were affected, the patient reported worst symptoms in her lateral three digits. The patient reported associated neck stiffness, but denied red flag symptoms.

Discussions: The carotid sheath sits in the retropharyngeal space, posterior to the sternocleidomastoid, and is composed of 3 layers of deep cervical fascia. Its contents comprise the ansa cervicalis, internal carotid artery, common carotid artery, CN IX-CN XII, deep cervical lymph nodes, and sympathetic plexus. A lesion may arise in any of the above-named structures. Knowledge of the structures involved is important in narrowing down a differential and rendering appropriate treatment. Tumors of the carotid sheath may be comprised of paragangliomas, such as carotid body tumors, nerve sheath tumors, neurofibromas, schwannomas, lipomas, carotid sheath meningiomas, and lipomas. When surgery is performed to remove these tumors, due to the small space and proximity to the cervical spine, cervical radiculopathy may become a chronic issue. In addition, excess cervical traction intraoperatively or adjuvant radiation therapy may lead to brachial plexopathy.

Conclusions: Although the patient reported numbness and pain coinciding with the carotid sheath tumor surgery, EMG findings coupled with physical exam are more consistent with cervical radiculopathy. The carotid sheath is proximal to the brachial plexus and a plexopathy or peripheral neuropathy is less likely than cervical radiculopathy for this patient despite the temporal association of symptoms and surgery.