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Sudden Quadriplegia after Acute Cervical Disc Herniation

Published online by Cambridge University Press:  02 December 2014

Venkatraman Sadanand ,
Michael Kelly ,
George Varughese  and
Daryl R. Fourney
Venkatraman Sadanand
Affiliation:
Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Michael Kelly
Affiliation:
Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
George Varughese
Affiliation:
Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Daryl R. Fourney*
Affiliation:
Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
*
Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, SK, S7N 0W8 Canada
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Abstract:

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Background:

Acute neurological deterioration secondary to cervical disc herniation not related to external trauma is very rare, with only six published reports to date. In most cases, acute symptoms were due to progression of disc herniation in the presence of pre-existing spinal canal stenosis.

Case report:

A 42-year-old man developed weakness and numbness in his arms and legs immediately following a sneeze. On physical examination he had upper motor neuron signs that progressed over a few hours to a complete C5 quadriplegia. An emergent magnetic resonance imaging study revealed a massive C4/5 disc herniation. He underwent emergency anterior cervical discectomy and fusion. Postoperatively, the patient remained quadriplegic. Eighteen days later, while receiving rehabilitation therapy, he expired secondary to a pulmonary embolus. Autopsy confirmed complete surgical decompression of the spinal cord.

Conclusions:

Our case demonstrates that acute quadriplegia secondary to cervical disc herniation may occur without a history of myelopathy or spinal canal stenosis after an event as benign as a sneeze.

Résumé:

RÉSUMÉ: Introduction:

Il est très rare d’observer une atteinte neurologique aiguë secondaire à une hernie discale cervicale qui ne soit pas reliée à un traumatisme externe. Seulement six cas ont été publiés. Dans la plupart des cas, les symptômes aigus étaient dus à la progression de la hernie en présence d’une sténose préexistante du canal spinal.

Observation:

Un homme de 42 ans a développé de la faiblesse et de l’engourdissement dans ses bras et ses jambes immédiatement après avoir éternué. À l’examen physique, il présentait des signes d’atteinte du neurone moteur supérieur qui ont évolué en quelques heures vers une quadriplégie C5 complète. L’IRM a montré une hernie discale C4-C5 massive. Il a subi d’urgence une discectomie cervicale antérieure avec fusion. Le patient est demeuré quadriplégique et il est décédé 18 jours plus tard d’une embolie pulmonaire au moment d’un traitement de réadaptation. L’autopsie a confirmé la décompression complète de la moelle épinière.

Conclusions:

Ce cas illustre qu’une quadriplégie aiguë secondaire à une hernie discale cervicale peut survenir sans histoire de myélopathie ou de sténose du canal spinal suite à un événement aussi banal qu’un éternuement.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 3 , August 2005 , pp. 356 - 358
Copyright
Copyright © The Canadian Journal of Neurological 2005

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