Acute-onset cervical spine pain and neurologic deficit in a previously healthy young woman William G. Schucany, MD
A previously healthy 36-year-old teacher presented to her primary care physician with new acute-onset cervical spine pain to the right of midline, right shoulder pain, and distal extremity numbness and tingling. Clinical evaluation revealed no significant muscular weakness or loss of normal reflexes. Sensory symptoms were distributed in the fourth through sixth dermatomes. Laboratory evaluation included a serum chemistry panel and complete blood count, the results of which were normal. The patient's vital signs were normal, and there were no known or preexisting medical conditions. The onset of symptoms occurred after the patient lifted a heavy bag filled with schoolbooks. She underwent routine magnetic resonance (MR) imaging with intravenous contrast material (Figures 1-6).
What is the most likely diagnosis based on the MR images and clinical history? What are reasonable differential diagnostic considerations? What is the most appropriate next step in the management of this case? |
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