Sudden nontraumatic tetraplegia associated with cervical disc herniation: Case report

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Sudden nontraumatic tetraplegia associated with
cervical disc herniationCase report

• Andrej Porcnik
• Borut Prestor
• University Medical center Ljubljana, Slovenia

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Background

• Cervical disc herniation is a rare cause of
  nontraumatic para- or tetraplegia and as such
  represents a true emergency.
• We present a case of acute nontraumatic
  tetraplegia secondary to cervical disc herniation
  with no associated previous spinal stenosis or
  previous signs of mielopathy.
• The pathophisiology of acute tetraplegia and need
  for urgent surgical decompression is presented.

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Case report

• A 37-year old men presented with sudden onset of
  muscle weakness in the arms and legs that quickly
  progressed.
• He had no history of head and neck trauma.
• The clinical picture was in accordance with the
  anterior spinal cord syndrome he finally
  developed acute C6 tetraplegia.

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Case report

• Sagittal T2-weighted (A) and T1-weighted (B)
  magnetic resonance images show a posteriorly
  protruding disc C5-C6 (arrowhead). There is
  increased signal intensity (arrow) in the spinal
  cord at the level of the C5-C6 disc (B). Axial
  T2-weighted (C) magnetic resonance image shows
  that the cervical cord is compressed at the level
  of the C5-C6 disc.

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Case report - operation

• Microdiscectomy C5-C6 was performed.
• His neurological condition improved during few
  days after the operation.
• Clinical picture was fully reversible C6
  tetraplegia.
• During the six year postoperative observation
  period he stayed symptom free.

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Case report

• Magnetic resonance imaging two years after the
  operation (A, B, C) showing decompression of the
  spinal cord at the level of the C5-C6 disc
  (arrowhead). On T2-weighted image (B) high signal
  intensity remained at the C5-C6 level in the
  central portion of the cervical spinal cord
  (arrow).

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Conclusion

• Cervical disc herniation should be considered in
  the differential diagnosis of acute
  nontraumatic para- or tetraplegia.
• Cervical herniation can cause diminished blood
  supply to the anterior spinal artery and anterior
  spinal cord ischaemia.
• Immediate magnetic resonance imaging and early
  decompressive surgery is recommended to avoid
  irreversible neurologic deficit.

Andrej Porcnik Borut Prestor University Medical
center Ljubljana, Slovenia