A 62 year old woman with no history of vertigo or dizziness, reported to the clinic for her scheduled therapy session for cervical degenerative joint disease. During the course of conversation, the patient reported experiencing dizziness after a shampoo treatment of her hair at a hairdressing salon. She had visited her hairdresser the previous day and reported severe vertigo, occipital pain, difficulty standing, and a periodic numbness of the right arm and leg. A recent radiograph and MRI of the cervical spine had shown cervical spondylosis and narrowing of the C4, and minor cervical compression at the same level.
Does this presentation/history warrant an upper quarter screening examination? Why or why not?
Given the history of dizziness/vertigo, periodic numbness of the right arm and leg, and imaging study results indicating cervical spondylosis, the patient certainly warrants an upper quarter screening examination.
Which of the subjective findings concern you most?
The periodic numbness of the right arm and leg. While the dizziness/vertigo could be benign (peripheral vertigo is manifested with general complaints such as unsteadiness and lightheadedness), simultaneous numbness of the right arm and leg is strongly indicative of a UMN lesion.
Which are the red flags associated with dizziness/vertigo should you be looking for?
Nystagmus. Central vertigo is usually caused by a cerebellar disorder, an ischemic process, or a disturbance of the vestibular system.
A thorough neuromuscular examination was performed. All of the clinical findings were normal except for the following: a glove and stocking-type hypesthesia in the right upper and lower extremities, disturbances of equilibrium, and nystagmus was present.
Given the findings from the early part of the examination, what is your course of action, or is further testing warranted?
There are enough signs and symptoms here for you to discontinue the examination and to contact the patient’s physician.
Describe the natural history involved in cervical myelopathy.
Discuss the static and dynamic mechanical factors that can be involved with cervical myelopathy.
Describe the upper motor neuron signs associated with cervical myelopathy.
If lower motor neuron signs occur in a patient with cervical myelopathy, at which level do they occur?
What are the surgical options available for a patient with cervical myelopathy and what are the indications for surgery?