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
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
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.