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Images in Neurology
March 2004

Absence of Lower-Limb Deficits Despite Severe Spinal Cord Atrophy

Arch Neurol. 2004;61(3):428. doi:10.1001/archneur.61.3.428

A 50-year-old man was examined because of a 2-year history of decreased upper-limb dexterity. Thirty years earlier, a cervical spinal cord lesion had been operated on and postoperative radiotherapy had been given. On neurological examination at the time of his current evaluation, abnormality was limited to the upper limbs. The patient had marked upper-limb atrophy with diffuse fasciculations, distally accentuated mild upper-limb weakness, decreased perception of light touch and pinprick from the C5 to C8 dermatomes, decreased perception of position at the fingers, and depressed upper-limb reflexes. Results of lower-limb examination, gait, and plantar response were normal. Magnetic resonance imaging of the cervical spine (Figure 1, A) showed a 1.7 × 1.4 × 1-cm oval enhancing lesion at the C2 to C3 level. There was a syrinx extending cephalad from this lesion up to C1, and posterior tethering of a markedly atrophic cord segment extending from C3 to C6-7 interspace was noted. The patient's laminectomy was reopened; the lesion was resected and proved to be a grade 2 ependymoma. He had mild gait difficulty and increase in the distal upper-limb weakness in the postoperative period. These symptoms had resolved at 3 months of follow-up, and magnetic resonance imaging (Figure 1, B) showed interval resection in the enhancing mass with no change in the tethered atrophic cervical cord.

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