Disclosures: Malaka Badri, DO: Nothing to disclose

Case Description: 60-year-old female with no past medical history who developed new onset neck pain with numbness and tingling in bilateral hands and feet after an episode of forceful coughing spell. She presented to an outside ED, where a head CT showed no abnormalities. She was discharged with neurology follow-up but was unable to follow-up due to insurance issues. Over the course of the following month, her symptoms worsened. She presented to the ED again with an abnormal gait. On physical exam, she was found to have hyperreflexia and clonus. Brain MRI showed a dysplastic skull base characterized by platybasia and cranial settling/basilar invagination. CT scan of cervical spine revealed cervicomedullary mechanical compression at C1/C2 abnormalities. Rheumatology work-up ruled out rheumatoid arthritis as the source of cord compression. She underwent a suboccipital craniotomy and C1 laminectomy with an Occiput-C5 fusion. Patient was admitted to acute inpatient rehabilitation requiring moderate assistance for transfers and ambulation. She was discharged home modified independent with a cane.

Setting: Acute Inpatient Rehabilitation Unit

Patient: 60-year-old female with platybasia who developed cervical myelopathy.

Assessment/Results: Platybasia is usually asymptomatic but can present with neck pain as was seen with the patient above. The patient reported her symptoms began after an episode of coughing and denied any acute cervical trauma. Given her history, the coughing fit was likely the cause of her cord compression in the setting of her platybasia.

Discussion: Platysbasia is a congenital flattening of the skull base and can be associated with other congenital abnormalities. This is the first reported case, to our knowledge, of spontaneous medulla-myelopathy after a coughing spell in a patient with congenital platybasia.

Conclusion: Presenting clinical symptoms of neck pain and headache following a coughing fit in asymptomatic platybasia should be recognized as a clinical manifestation of cervical myelopathy.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unusual-trigger-of-medullo-myelopathy-in-asymptomatic-platybasia-a-case-report/