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Tremors as an atypical presentation of cervical myelopathy

 Department of Orthopaedic Surgery, Division of Spine, Tan Tock Seng Hospital, Singapore

Correspondence Address:
Jacob Yoong-Leong Oh,
Department of Orthopaedic Surgery, Division of Spine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmedsci.jmedsci_75_19

Tremors are common especially in the elderly population. However, tremors occurring secondary to cervical myelopathy are rarely reported. We report the case of a 91-year-old gentleman who was admitted to the neurology service with chief complaints of bilateral upper-and lower-limb tremors. This had progressed rapidly over2weeks to the extent that he was not able to feed himself and was unable to walk without support. An initial working diagnosis of Parkinson's disease was made but was later dismissed because of the atypical features. Amagnetic resonance imaging of cervical spine was subsequently performed which revealed a large disc herniation at C3–C4 level, causing severe spinal canal stenosis and cord compression. Given this radiological presentation and the absence of other objective pathologies on further investigations, we correlated his symptoms to the underlying cervical cord compression. He underwent anterior cervical discectomy and fusion which led to complete resolution of tremors by 8weeks postsurgery. His unsteadiness eventually resolved, and there was no recurrence of tremors throughout our follow-up period. This case highlights a rare atypical presentation of cervical myelopathy as peripheral limb tremors. The diagnostic dilemma, management strategies, and hypothesis to explain this phenomenon are discussed.


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