Severe cervical compressive polydiscopathic myelopathy with features of motor neuron disease: A case report

Abstract

Cervical myelopathy is a well-known cause of disability among elderly. It is included in the amyotrophic lateral sclerosis (ALS) mimic syndrome and could resemble motor neuron disease. We present the case of a 70-year-old patient with severe cervical compressive polydiscopathic myelopathy with clinical findings of motor neuron disease. Cervical myelopathy is a widely spread cause of disability among elderly. 1 The clinical decline is progressive, and this condition should be taken into consideration in patients over 55 years old with loss of motor control of the upper limbs, gait disorders, or sphincter dysfunction. Quality of life could be severely impaired in these patients, evidence showing that beyond the motor, sensory, and bladder dysfunctions recorded with myelopathy scales, there is also impairment of emotional and mental health. 2 There are several diseases reunited together under the name of amyotrophic lateral sclerosis (ALS) mimic syndrome which can present with a clinical phenotype of motor neuron disease and therefore require to be considered as a differential diagnosis. As ALS is a progressive disease, with disability and with a fatal prognosis, the implications of a misdiagnosis can be of a great importance for patients and their relatives. 3 In population-based studies, it is estimated that 8%-10% of patients referred to a tertiary referral MND (motor neuron disease) center with a diagnosis of ALS will ultimately turn out to have another condition. 4 At the same time, a recent review describes a number of clinical presentations of ALS with (a) motor neuron involvement (ALS or primary lateral sclerosis, or upper motor neuron predominant ALS, or progressive muscular atrophy, or lower motor neuron predominant ALS); (b) bulbar or spinal onset; (c) focal onset (progressive bulbar palsy, pseudobulbar palsy, flail arm and flail leg); and (d) cognitive involvement (ALS with cognitive impairment and ALS with frontotemporal dementia). 5 One of the clinical entities of ALS mimic syndrome that can resemble motor neuron disease is cervical myelopathy, which has a better prognosis than ALS and can be alleviated by neurosurgical intervention in most of the cases. Therefore, a clear separation of these entities at the early stage is mandatory