Panayotis Jusakos, MD
PMR Resident
One Brooklyn Health
orlando, Florida, United States
Vince Song, BA
Medical Student (MS4)
Touro College of Osteopathic Medicine
New York, New York, United States
Michael Sposito, MD
Resident Physician
One Brooklyn Health
Brooklyn, New York, United States
Charlene Canales, DO
Resident Physician
One Brooklyn Health
Woodside, New York, United States
Daniel Sanchez, MD
PM&R Resident
One Brooklyn Health/Kingsbrook Jewish Medical Center
Woodbridge, California, United States
Marc K. Ross, MD
Chair, Department of Rehabilitation Medicine
OB001
Brooklyn, New York, United States
A 64-year-old female with a past medical history of COPD, asthma, and osteoarthritis presented with a 1-year history of progressively worsening numbness and weakness in all four extremities. Initial symptoms included bilateral lower extremity paresthesia’s, which progressed to numbness and weakness resulting in muscle loss and giant imbalance. Symptoms progressed and later started affecting bilateral upper extremities. The patient’s condition led to wheelchair dependence. Imaging revealed multilevel cervical stenosis with disk osteophyte complexes from C3 through C7 and moderate cord compression at C3-C4 with myelomalacia. Anterior cervical discectomy was performed, followed by inpatient rehabilitation due to functional decline and gait disorder. Post-operatively, the patient experienced almost complete resolution of numbness and tingling in the upper extremities, with gradual improvements in the lower extremities through inpatient rehab, leading to discharge to home after.
Cervical myelopathy commonly presents with upper extremity symptoms, including weakness and sensory disturbances. This case exemplifies an atypical presentation where initial symptoms were predominantly lower extremity weakness and gait imbalance, a scenario less frequently associated with cervical myelopathy. The absence of early upper extremity symptoms may contribute to delayed diagnosis and treatment. This highlights the necessity of including cervical myelopathy in differential diagnoses for patients presenting with progressive lower extremity symptoms, even when traditional upper extremity signs are not evident. Early recognition and intervention are crucial to prevent functional deterioration and optimize recovery.
Cervical myelopathy can manifest atypically with primary lower extremity symptoms and gait instability, potentially preceding traditional upper extremity manifestations. This case emphasizes the need for heightened clinical awareness and thorough diagnostic evaluation in such atypical presentations. Prompt surgical intervention can significantly improve outcomes, highlighting the importance of recognizing and addressing cervical myelopathy in patients with non-classical symptom profiles to prevent further functional decline and facilitate recovery.
