Disclosures: Michael Fragner: No financial relationships or conflicts of interest

Case Diagnosis: A unique case of neck pain and imbalance as a result of cervical spondylosis and superficial siderosis

Case Description: A 65 year old male with a significant past medical history of TBI, fracture of the C2 vertebrae, bipolar personality disorder, and chronic migraines presented with a chief complaint of neck pain, worsening memory and impaired balance for the past year. Prior treatment included botox for migraines, physical therapy for axial neck and low back pain, and extensive pharmacologic treatment including opioids, gabapentin, and NSAIDs. Exam findings were notable for hyperreflexia in all extremities, bilaterally positive Hoffman’s sign, and significantly impaired tandem walking. Cervical MRI without contrast revealed diffuse cerebellar siderosis predominantly involving the superior half of the cerebellum. Imaging also suggested siderosis along the cervical cord surfaces and cervical spondylosis.

Setting: Outpatient musculoskeletal practiceAssessment/

Results: Impaired balance secondary to superficial siderosis. Axial cervical pain secondary to spondylosis.

Discussion: When working up a patient with a history of cervical trauma who presents with neck pain and impaired balance, conventional practice is to initially suspect myelopathy, syrinx, or nerve impingement. However, as in this case, detailed review of imaging may yield alternative diagnoses. Cervical spine MRI was obtained given the clinical findings consistent with an upper motor neuron lesion. After reviewing the images a diagnosis of superficial siderosis was made. Further work up includes Neurology consultation and a dedicated MRI of the brain without contrast. Patient was prescribed physical therapy focused on balance and gait training.

Conclusion: Similar to other cases of cerebellar siderosis, this patient had a history of brain and cervical trauma. Given his MRI results, it’s likely that his siderosis contributed to his myelopathic-like presentation. Therefore, in such cases, superficial siderosis should be considered as a differential when providing a thorough workup in an outpatient setting.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/atypical-cause-of-balance-impairment-in-a-patient-with-neck-pain-as-a-result-of-superficial-siderosis-stemming-from-cervical-spine-trauma-a-case-report/