500 - Cervical radiculopathy secondary to a rare intramedullary neoplastic process

Case Diagnosis: Cervical radiculopathy secondary to a rare intramedullary neoplastic process

Case Description: Patient is a 36yo male with a significant PMH of TBI in 2010 and HTN who initially presented to Emergency Department after 3 weeks of intermittent cervical neck pain with no inciting event, now progressively constant with severe non-dermatomal radiating symptoms into right upper extremity and right mandible. Patient was instructed to follow up with PM&R, where exam revealed decreased sensation in C5 and C8 dermatome on the right, deep tendon reflexes 1+/4 in the bilateral upper extremity, negative Hoffmann's bilaterally, reproduction of pain with forward flexion of the neck, positive Spurling’s test on the right, and no deficits in motor strength. Patient started on gabapentin for neuropathic pain and MRI cervical spine w/o contrast was obtained, which revealed an intramedullary mass spanning the C6-T2 levels with associated symmetric expansion of the cervical cord, concerning for ependymoma or astrocytoma. Referral was made to Neurosurgery and MRI with/without contrast was ordered.

Discussions: This case provides the opportunity to understand a unique etiology and presentation of cervical radiculopathy, as well as noting the importance of evidence-based radiculopathy physical exam tests and expedited further imaging to characterize rare causes of radiculopathy. Furthermore, this case presents the significance of timely communication and multidisciplinary care with a neurosurgical team for evaluation of potential surgical interventions in the setting of a rare neoplastic process within the spinal cord.

Conclusions: Evaluation of cervical radiculopathy and confirmatory diagnosis with etiology thereof is frequent in the physiatry outpatient clinic; however, this case lends importance to an accurate radiculopathy screening, as well as revealing a rare cause of radiculopathy with the subsequent need for appropriate imaging and multidisciplinary surgical evaluation.