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Robert B. King and William L. Stoops

appropriate despite widespread fasciculations in the lower extremities of patients with other signs and symptoms of cervical radiculopathy and myelopathy caused by cervical spondylosis. Summary 1. Three patients have been described with cervical spondylosis and fasciculations at rest in the lower extremities. All have had findings of compression of the cervical cord secondary to cervical spondylosis. Electromyography has not shown fibrillations of denervation in the lower extremities of these patients. Following cervical laminectomy and foramenotomy, the signs

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Albert N. Martins, Ludwig G. Kempe, David T. Pitkethly and Darwin J. Ferry

magnitude of these encroachments surprised us. Moreover, the characteristics of the myelographic filling defects in the asymptomatic subjects were indistinguishable from many of those encountered in our symptomatic patients who underwent surgery for their disease ( Fig. 1 ). One seems justified, therefore, in concluding that, unless the clinical findings permit a clear-cut diagnosis of cervical radiculopathy, cervical myelography is apt to confuse the picture by demonstrating abnormalities of the spinal canal or neural foramina with no clinical significance. Furthermore

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Chikao Nagashima

110/70 dizziness, 9th, 12th nerve paresis right, cerebellar signs, cervical radiculopathy C5–6 improved 3 47 M 72 100/60 blurred vision, dysphagia, shoulder, neck, and headache, cervical radioculopathy C6–7 improved 4 54 F 21 120/90 dizziness, blurred vision, faintness sensation, nausea, neck pain C5–6 C5–6 excellent 5 66 M 6 140/100 vertigo, oscillopsia, numbness in arms and legs C5–6 excellent 6 44 F 22 140/90 vertigo, transient blindness, faintness sensation, headache C6–7 C6

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Richard A. Smith, M. Darius Vohman, Joseph H. Dimon III, James E. Averett Jr. and James H. Milsap Jr.

cervical spine films and tomograms showed dense, oval-shaped calcification measuring 5 × 16 mm in the C4–5 intervertebral disc space ( Fig. 3 ). Myelography outlined a filling defect obliterating the root sleeve at C4–5 on the right ( Fig. 4 ). The impression was that of right fifth cervical radiculopathy secondary to herniation of the calcified intervertebral disc. Fig. 3. Case 3. Left: Lateral cervical spine film showing large oval disc calcification at C4–5. Right: Anterior tomogram demonstrating irregular calcification within the disc. Fig. 4

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Foramen magnum tumors

Analysis of 57 cases of benign extramedullary tumors

Shozo Yasuoka, Haruo Okazaki, Jasper R. Daube and Collin S. MacCarty

brevis. There were also motor units of increased duration and decreased number of firings in the distal muscles of both upper extremities and in the proximal muscles of the left upper extremity, but there was no abnormal finding in the paraspinal muscles. The EMG was interpreted as showing a chronic denervation process involving C-8 and T-1 roots and as being consistent with bilateral lower cervical radiculopathy, but this also could result from a cervical intraspinal lesion. The results of pathological exploration and the EMG are conflicting and make it difficult to

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Timothy Mapstone and Robert F. Spetzler

spondylotic spurs can result in vertebrobasilar insufficiency has become apparent over the past 20 years. 4, 6, 7 Surgical treatment of this disease is feasible and desirable. The midline approach using discectomy, osteophyte removal via the disc space, and bone fusion has been recommended by some and may be appropriate in patients with signs and symptoms of cervical radiculopathy and myelopathy referrable to that level. 1, 8 Others have suggested that a safer and quicker approach is to unroof the bone canal of the foramen transversarium using the lateral approach, thus

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George Ehni and Benjamin Benner

( Fig. 2 upper right ). Fig. 2. Case 2. Upper Left: Lateral radiograph of the cervical spine revealing loss of cervical lordosis, arthrotic narrowing of the C5–6 and C6–7 interspaces, anterior spurs at C5–6, and posterior spurs at C5–6 and C6–7. Changes of this sort and at these levels of the spine have been credited with causing headache in the absence of any indication of cervical radiculopathy. Lower: Open-mouth radiographic view of the C1–2 lateral articulations showing arthrotic destruction of the joint space on the painful (left) side and a normal

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Suprascapular nerve entrapment

A summary of seven cases

Mark N. Hadley, Volker K. H. Sonntag and Hal W. Pittman

traumatic or rheumatoid), infraspinatus tendonitis, calcific abscess, and adhesive capsulitis. A significant number of these patients will have been seen by orthopedic surgeons prior to seeking neurosurgical evaluation. Shoulder pain can also be the presenting symptom in cervical radiculopathy, primarily of the C-5 root. A detailed history and physical examination aided by electromyography (EMG) and nerve conduction velocity (NCV) studies should result in the correct diagnosis. We present our experience with seven patients with suprascapular nerve palsy. The treatment

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Vincent C. Traynelis, Gary D. Marano, Ralph O. Dunker and Howard H. Kaufman

quadriplegic; 9, 20, 22 however, hemiparesis is a more common occurrence. 12, 14, 25, 27, 30 While Table 1 attributes quadriplegia and hemiparesis to a spinal cord injury, brain-stem damage could also cause these deficits as illustrated in the case presented by Rockswold and Seljeskog. 27 There may be hemiplegia with a dissociated hemisensory deficit giving a Brown-Séquard type of presentation. 23 The upper cervical roots may be injured in conjunction with atlanto-occipital dislocation. Multiple unilateral cervical radiculopathies may mimic a brachial plexus palsy. 30

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Jeffrey V. Rosenfeld, Andrew H. Kaye, Stephen Davis and Michael Gonzales

, 19, 20 trauma, 3, 15 toxins, 15 metabolic disease, 18 and rheumatoid arthritis 9 have all been implicated. We are reporting a case of idiopathic pachymeningitis cervicalis hypertrophica causing cervical radiculopathy, which responded well to surgery. Case Report This 25-year-old male hairdresser presented with a 1-month history of increasing pain in the left side of the neck and left arm, associated with weakness and numbness of the left arm. He had fallen onto the outstretched left hand just prior to the onset of the pain. First Admission On