Disclosures: James L. Morgan, MD: Nothing to disclose

Case Description: Patient presented with progressive right sided hemiparesis. Her symptoms originally started with insidious right lower extremity impairment and then new right hand dysfunction. This acute right hand dysfunction prompted medical attention. Baseline, patient had significant left lower extremity impairment yet relatively preserved bilateral upper extremity function which she required for maintaining household independence. Patient was treated for MS exacerbation with intravenous solumedrol with improvement. Physical Medicine & Rehabilitation was consulted at this time, and after thorough chart review advised surgical consult related to cervical spine MRI abnormality showing disc extrusion at C5-6 with severe right sided central canal stenosis, cord indentation, and lateral recess narrowing. Patient underwent emergent C4-6 ACDF and was eventually admitted to IRF.

Setting: Inpatient Rehabilitation Facility (IRF).

Patient: 62-year-old right handed female with past medical history significant for relapsing and remitting multiple sclerosis (RRMS) and C4-5 Anterior cervical discectomy and fusion (ACDF).

Assessment/Results: At discharge from IRF, patient returned to her previous functional level, with previous left lower extremity impairment.

Discussion: MS and CM can have similar presentations making treatment decisions based on underlying etiology difficult. RRMS is the most common type of MS, defined by exacerbations of disease progression with full or incomplete recovery. RRMS can also develop into secondary progressive MS. CM typically presents insidiously with gait dysfunction early on. Sensory deficits of the hands resulting in functional impairments is a common sign for severe disease progression. Both pathologies can present with gait instability, upper or lower extremity weakness, bowel/bladder dysfunction, sensory loss, and spasticity leading to varying degrees of disability.

Conclusion: It may be difficult for clinicians to distinguish between MS exacerbation and cervical myelopathy given similar presentation. However, starting with a wide differential diagnosis, detailed functional history, physical exam, and appropriate imaging can lead to a proper diagnosis and management to minimize disability.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/multiple-sclerosis-ms-exacerbation-or-cervical-myelopathy-cm-or-both/