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PROGRESSIVE CERVICAL MYELOPATHY: THREE CASE REPORTS DESCRIBING DIFFERENTIAL DIAGNOSIS AND MANAGEMENT. Elliott RL, Ross MD, Greene KA, Bang MD; Departments of Medicine and Physical Therapy, Kaiser Permanente Medical Center, Vallejo, CA, USA. randjelliott@earthlink.net. PURPOSE AND FOUNDATION: Cervical myelopathy (CM) most commonly occurs in older individuals secondary to spondylitic changes causing spinal cord compression. Because the early signs of CM are often subtle, the diagnosis may be missed. This report describes the clinical history of 3 patients diagnosed with CM after being referred to physical therapy (PT) for treatment of seemingly unrelated musculoskeletal conditions. DESCRIPTION AND OBSERVATIONS: Patient #1 was a 63 year-old man referred to PT for left knee "cramping" and low back pain. Physical examination revealed left calf atrophy and weakness. After minimal gains with PT, the patient was referred to the spine specialty clinic where he was diagnosed with an S1 radiculopathy and scheduled for lumbar surgery. Upon PT reassessment, the patient presented with an ataxic gait pattern and hyperreflexia. Magnetic resonance imaging of his cervical spine confirmed a diagnosis of CM. Because the impairments most impeding to the patient’s function were thought to be more related to CM than S1 radiculopathy, he underwent surgical decompression of the cervical spine; his surgical outcome was successful. Patient #2 was a 50 year-old woman referred to PT for neck pain and bilateral upper extremity "tightness". With routine questioning regarding signs and symptoms associated with spinal cord compression, the patient reported recent difficulties with maintaining balance while walking. Physical examination revealed an ataxic gait and hyperreflexia. Over the brief course of PT, her physical examination findings became more pronounced. Magnetic resonance imaging of her cervical spine confirmed a diagnosis of CM and surgical options were being considered at the time of this submission. Patient #3 was a 75 year-old man referred to PT for right knee pain. Physical examination revealed mild left sided weakness. According to the patient, this weakness was due to multiple sclerosis, which was initially diagnosed 30 years ago. However, there was no evidence in his medical record to confirm a diagnosis of multiple sclerosis. Over the course of the patient’s treatment for knee pain, his left sided weakness became more pronounced and his gait became ataxic. Other findings included hyperreflexia and lower extremity clonus. Magnetic resonance imaging confirmed a diagnosis of CM but not multiple sclerosis. The patient subsequently underwent successful surgical decompression of the cervical spine. CONCLUSIONS: Timely diagnosis of progressive CM is important so the condition can be managed appropriately. Therefore, in patients with progressive neurological impairments, CM should be considered in the differential diagnosis. FUNDING SOURCE: None.
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