Case 180

Basic Human Neuroanatomy

A Clinically Oriented Atlas

Case History #180

Date of Consultation: 11-27-1989

HISTORY OF PRESENT ILLNESS:

This 40-year-old right-handed white female special education teacher was referred for neurologic evaluation of her neck pain and sensory symptoms. The patient’s difficulties with neck pain began seven years prior to consultation (1982), after she was involved in a motor vehicle accident. In this accident, she was rear-ended and sustained a flexion-extension injury. She was diagnosed as having a cervical sprain and was treated accordingly. Her symptoms of neck and upper shoulder girdle pain and muscle spasms have continued to the present, although they fluctuate in intensity.

Approximately three months prior to consultation (August 1989), she noted that when she flexed her neck, she would experience a numb and tingling sensation radiating from the neck down both upper limbs and into the hands and fingers. At times, this same sensation would spread down the vertebral column into the midthoracic region. The symptoms only lasted for a few seconds while the neck was flexed. Once she straightened the neck, the symptoms remitted. She also noted that occasionally she experienced a sharp, shooting pain from the posterior neck region upward onto the occipital region of her head. The only factor that triggered off this sensation was flexion of the neck. The overall course of this symptom complex was one of stability, without any progression or remission.

The patient’s neurologic review of systems, aside from the above, was essentially unremarkable. She has had no other neurologic problems in the past.

NEUROLOGICAL EXAMINATION:

Mental Status Exam: Intact.

Cranial Nerves: Intact.

Motor System: Intact.

Reflexes: Intact.

Sensory System: All modalities of sensation, including cortical sensations, were normal. There were no sensory deficits in the posterior head, neck, or upper limbs.

Cerebellar Function: Intact.

Gait and Stance: Intact.

Questions

1. Is there evidence of peripheral nerve involvement in this case, and, if so, what nerve(s) is involved?

2. Is there evidence of dorsal or ventral root involvement or spinal nerve involvement in this case, and, if so, what is the level(s) of the involvement?

3. Is there evidence of spinal cord involvement in this case and, if so, at what level? Indicate the structures involved by the pathologic process.

4. The symptoms experienced by this patient in the three months prior to consultation constitute a classic neurologic symptom complex. What is the name of this phenomenon?

5. What is thought to be the underlying mechanism producing this symptom complex?

6. Name the two most common conditions associated with this symptom complex.

7. In general, what type of pathologic process do you think is involved in this case?

8. What diagnostic procedure(s) would you undertake at this point?

Answers