Cervical and Thoracic Myelopathy Presenting as Atypical Chest Pain and Abdominal Pain: A Case Report
PM & R
Case Diagnosis: Cervical and Thoracic Myelopathy Presenting as Atypical Chest Pain and Abdominal Pain Case Description: A 64-year-old male with medical history significant for metastatic rectal/colon cancer, CAD with recent PCI three weeks prior to admission presented with chest pain, abdominal pain, and urinary retention. Cardiac and abdominal workup were unremarkable. One day after admission, he awoke with left-sided weakness. Neurology was consulted. On evaluation, he had left hemiparesis with upgoing plantar response. Head CT showed remote left cerebellar infarct; symptoms were attributed to CVA. MRI was deferred due to claustrophobia. Two days later, he developed bilateral lower extremity weakness, worsening urinary retention and saddle paresthesias. Imaging included MRI L-spine which was unremarkable; MRI Cspine showed severe DDD at C5-6, C6-7 and large extruded disc in epidural space causing high grade central canal stenosis and spinal cord deformity. MRI T-spine showed left paracentral disc herniation at T6-7 compressing T6 nerve root. Setting: Tertiary care hospital Assessment/Results: He underwent C5-6 ACDF with partial corpectomy. He was transferred to inpatient rehabilitation unit with some motor recovery. He had little improvement in abdominal pain. He deferred treatment of thoracic disc herniation. Discussion: This case is unusual given two disc herniations without specific inciting event. Given no clear reason for autonomic symptoms during workup and weakness initially attributed to CVA, this confounded the neurologic involvement related to spinal cord injury. Literature review illustrates that radicular/myelopathic pain in cancer is commonly attributed to spinal metastases, however, the literature isn’t clear regarding development/higher susceptibility for disc herniation. Conclusion: Spinal metastases is high on the differential in cancer patients with new neurological complaints. It’s worthwhile to evaluate for correlation between DDD (and consequently higher likelihood for disc herniation) and cancer. It also raises question of chemoradiation impacting bony anatomy and ligamentous spinal structures, in addition to accelerating DDD. Level of Evidence: Level IV
Bazil T, Chamberlain C. Cervical and thoracic myelopathy presenting as atypical chest pain and abdominal pain: a case report. 2021 Nov 19; PM & R 13(S1):S122.