| CASE REPORT |
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| Year : 2015 | Volume
: 6
| Issue : 2 | Page : 92-96 |
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Cervical myelopathy due to single level disc herniation presenting as intramedullary mass lesion: What to do first?
Murat Sakir Eksi1, Emel Ece Özcan Eksi1, Baran Yilmaz2, Zafer Orkun Toktas2, Deniz Konya2
1 Department of Orthopedic Surgery-Spine Center, University of California, San Francisco Medical Center, California, USA
2 Department of Neurosurgery, Bahçesehir University Medical School, Istanbul, Turkey
Correspondence Address:
Dr. Murat Sakir Eksi
University of California, San Francisco, Medical Center, 500 Parnassus Avenue MU320 West, San Francisco, California 94143-0728
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-8237.156073
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Cervical myelopathy (CM) is mostly a degenerative process ending in myelopathic and/or radiculopathic syndromes. On T2-weighted magnetic resonance imaging (MRI), CM appears as a hyperintense area near the spondylotic spine. This high intensity signal depends on the impact of outer forces and their duration. It also determines the prognosis of the surgical candidate. A 40-year-old male patient admitted to our clinic with right upper extremity weakness and hypoesthesia that had started 2 months earlier. On neurological examination there was 2/5 motor weakness of right biceps brachii, and hypoesthesia over right C6 dermatome. Right upper extremity deep tendon reflexes were hypoactive, but lower ones were hyperactive. After clinical and radiological work-up, preliminary diagnosis was directed to a spinal intramedullary tumor. Total resection of the herniated cervical disc fragment and the mass lesion was managed. Pathology of the mass lesion was compatible with subacute infarct tissue and inflammatory response. Final diagnosis was CM under effect of cervical disc herniation. Contrast-enhanced spinal cord myelopathic lesions are very rare and resemble much more tumors and inflammatory processes. However, the principal treatment approach totally differs depending on pathology. When there are both a disc herniation and a high clinical suspicion; biopsy should be delayed. The most probable solution will be surgery for the disc disease with thorough preoperative scanning of vascular malformations; clinical and radiological close follow-up after surgery. Biopsy or surgical resection can be performed if patient deteriorates despite the primary surgery. |
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