The patient  is a physician came to the clinic 22-August-2004 complaining of ataxic gait with weal upper left limb with lesser degree of the left lower limb and hypalgesia of the ulnar distribution of the left upper limb with loss of sensation of the right lower limb below the knee. These complains as he claimed persisted for 4 months.

The patient  is a known hypertensive for 4 years in angiotec and under treatment with kemadrine and clopixol for schizophrenia  for several years, which he refused to give details about it.

On examination: The patient is unable to stand for Romberg test with severe weak flexion and extension of the left hand and the left triceps muscle. There is weak both feet muscles 4/5 and the left quadriceps muscle 4/5. The deep tendon reflexes are exaggerated in the left side of the body with mild dysarthria and flattening of the left nasolabial fold. Rossolimo and Hoffmann are positive in the left side and Babinski positive left side. There is loss of sensation for pin=brick below the right knee and the ulnar distribution of the left upper limb.

The clinical manifestations were of Brown-Sequard syndrome with left C5-6 involvement.  Suspicion about multiple sclerosis or transverse myelitis, for what MRI of the brain with MRI of the cervical spine were requested.

The patient came back 15-December-2004 with severe deterioration of his condition with increasing weakness of his four limbs with inability to walk. He brought with him the MRI investigations. MRI of the brain was almost normal, but the MRI of the cervical spine showed massive malacia of the spinal cord, partially old and partially edematous extending from C4 down to C7 with severe compression of the spinal cord due to extruded disc C5-6.

Considering that the malacia was more wide spread than the compressive lesion, still suspicion about transverse myelitis  or compression of the anterior spinal artery or arteriitis  remained.

Considering his severe deterioration, it was explained to the patient, that he needs surgery to remove the compression and that the morphologic changes of the spinal cord will remain, but his improvement is related to the nature of the pathologic changes of the spinal cord.

The patient was operated  and discectomy of the C5-6 was achieved with decompression of the dura at that level using the high-speed drill and micro-instrumentations. The dura was very thin and transparent, that the spinal cord could be seen through it. Smooth postoperative recovery.