Disclosures: Anita Garg, DO: Nothing to disclose

Case Description: Spinal pilocytic astrocytoma

Setting: Outpatient MSK clinic

Patient: A 32-year-old male presented with gradual onset, intermittent, aching left shoulder and neck pain since 2007 associated with subjective feeling of left arm weakness. He denied any radiation of pain, numbness, tingling, balance issues, or bowel and bladder incontinence.

Assessment/Results: Physical examination revealed muscular body habitus with full, painless, cervical and bilateral upper limb range of motion. Motor strength and sensation was full and intact in bilateral upper extremities with normal muscle tone. There was no ankle clonus, plantar reflexes were downgoing, and Hoffman’s sign was mute. Biceps, pronator teres, and triceps stretch reflexes were notably absent in the left upper extremity but present in all other extremities. Cervical MRI revealed a well-defined, heterogeneously enhancing intramedullary lesion at C4 with diffuse edema from C2 through C7. The patient underwent surgical resection of the lesion which was identified as grade one pilocystic astrocytoma.

Discussion: Intramedullary spinal cord tumors are rare, with 1.1 cases per 100,000 persons, though the true incidence of spinal pilocytic astrocytoma is unknown. This condition is most common in the pediatric population and incidence decreases with age. Symptoms, most commonly pain and weakness, often precede diagnosis by years, as seen in this case, due to the slow growth rate of these tumors. This case underscores the need for a thorough physical examination, since the absence of multiple unilateral upper limb reflexes was the only positive finding leading to the diagnosis through obtaining MRI.

Conclusion: This case emphasizes the importance of performing a detailed neurologic examination, including stretch reflexes. Areflexia is a clue that the spinal cord, nerve root, or peripheral nerve has been damaged, and it is essential for clinicians to delve deeper into the cause. Although rare, physiatrists should maintain a high suspicion for spinal tumor when areflexia is found.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cervical-intramedullary-spinal-pilocytic-astrocytoma-presenting-with-solely-unilateral-upper-extremity-areflexia-a-case-report/