Radiculopathy C8-T1 atypical initial presentation: a case report

Abstract

Introduction: Radiculopathy is a common condition whose symptoms can include pain, sensory change, and motor weakness owing to mechanical and chemical irritation of the spinal nerve root. The aim is to report atypical clinical presentation of radiculopathy secondary to neoplasia. Case report: A 62-year-old male patient was admitted with pain in the right scapular region of onset 2 months ago and progressive worsening. On patient admission, he presented isolated loss of strength in the right hand with force grade V in the proximal right upper limb and right dropped hand and living reflexes in the right upper limb. Thoracic/cervical spine magnetic resonance imaging with expansive formations in the thoracic bone marrow of neoplastic aspect, compressive fracture of the vertebral body of T1 with impairment of the thoracic cord, reduction of the vertebral canal at level C3-C4. Electroneuromyography: bilateral acute C8-T1 radiculopathy, worse right and chronic radiculopathy on the left. Subsequently, he evolved with brachial paraparesis, exalted global osteotendinous reflexes, and inexhaustible clonus in the lower limbs. C4-T5 posterior cervical arthrodesis was performed. Discussion: Cervical radiculopathy may leave the clinician perplexed by lack of clinical-radiological correlation. Of special interest is the weakness of the intrinsic hand muscles without radiological evidence for C8 radiculopathy. Overlapping with the T1 root, the C8 root innervates the finger flexors and all the intrinsic hand muscles. C8 radiculopathy is characterized by radicular neck pain, hand weakness, and sensory deficit of the ulnar fingers and medial forearm. Conclusion: The lack of clinical-radiological correlation should not mislead the clinician from the correct diagnosis, and should not delay the surgical decompression of the cord and the roots.