2456 Cervical cord compression: a unique presentation of McArdle sign

ObjectivesWe report a unique case of McArdle sign secondary to extrinsic cervical cord compression. McArdle sign is the presence of rapidly reversible weakness induced by neck flexion. It is thought to be entirely specific and 65% sensitive for a diagnosis of MS, although other aetiologies should be...

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Published in:BMJ neurology open 2022-08, Vol.4 (Suppl 1), p.A66-A67
Main Authors: Singh, Indumathi, Nagaratnam, Sai, MoralesBriceno, Hugo
Format: Article
Language:English
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Summary:ObjectivesWe report a unique case of McArdle sign secondary to extrinsic cervical cord compression. McArdle sign is the presence of rapidly reversible weakness induced by neck flexion. It is thought to be entirely specific and 65% sensitive for a diagnosis of MS, although other aetiologies should be considered.MethodsA 43-year-old male presented with a 4-month history of progressive lower limb spasticity, numbness and associated gait unsteadiness. There was no relevant background history or trauma. Cranial nerve examination was unremarkable. Tone was normal in the upper limbs, with positive Hoffman’s sign bilaterally and hyperreflexia. Power was normal with neck in neutral. With neck flexion, there was significant proximal upper limb weakness, rapidly improved with neck extension. Deep abdominal reflexes were increased with absent superficial abdominal reflexes, in keeping with reflex dissociation. Bilateral pes cavus was noted. The left foot remained fixed in inversion with rigidity and hyperreflexia in both lower limbs. Plantar responses were upgoing. Vibration sense was reduced to the shins bilaterally.ResultsMRI cervical spine revealed a marked left posterolateral disc and osteophyte complex at C3/C4 compressing the cervical cord, with abnormal cord signal. Nerve conduction studies were normal apart from reduced sural responses bilaterally. He underwent C3/C4 anterior cervical discectomy with fusion and resolution of McArdle sign.ConclusionsMcArdle’s while thought to be specific for demyelinating pathology, may also be related to other aetiologies of myelopathy as outlined in this case. Neurologists should remain aware of this finding in patients presenting with a spinal cord syndrome.
ISSN:2632-6140
DOI:10.1136/bmjno-2022-ANZAN.181