Author: Thomas Mac Mahon / Editor: Vinesh Ramiah / Reviewer: Rafeeq Sulaiman / Codes: IP1, MuP3, NeuP8, SLO1 / Published: 01/07/2022
A 72-year-old female presents to the Emergency Department with a four week history of worsening neck pain, lethargy, reduced sensation and difficulty with fine motor movements in her upper limbs.
Symptoms are more pronounced in her right forearm and hand.
Her medical history includes COPD, cervical spine osteoarthritis, childhood rheumatic fever, hypertension, glaucoma and a raised body mass index.
Initial observations show a pyrexia of 38.3°C, pulse rate of 75/min, oxygen saturations of 98% on room air and a blood pressure of 163/99. She has mild discomfort on passive neck movement in all directions. She has marked bilateral upper limb hyperreflexia, reduced power (4/5) in her right forearm flexors and intrinsic hand muscles (median nerve distribution), a positive Hoffmann’s reflex bilaterally, and an ataxic gait. She has no rash, neck stiffness or photophobia. Cranial nerves are intact. Pupils are equal and reactive. Cardiovascular, respiratory and abdominal examinations are unremarkable.
Her blood tests show a mildly raised white cell count of 12.0 and haemoglobin of 9.7 (MCV 72.8). Her CRP is 17.2.
Chest x-ray and ECG are unremarkable. Urinalysis shows +RBC. X-ray of her cervical spine shows marked degenerative changes.