Nuffield Health Brighton Hospital, Brighton, United Kingdom; Department of Anatomy, Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom.
Royal Sussex County Hospital, Brighton, United Kingdom.
World Neurosurg. 2020 Dec;144:200-204. doi: 10.1016/j.wneu.2020.08.179. Epub 2020 Sep 2.
To our knowledge, this is the first case report of a cervical disc prolapse and foraminal stenosis presenting with dystonic tremor in addition to brachialgia.
A 54-year-old, right-handed man presented with a dystonic tremor and aching throughout his right upper limb. Magnetic resonance imaging of the cervical spine revealed a disc osteophyte complex at C5/6 causing C6 foraminal impingement bilaterally in addition to a disc osteophyte complex at C6/C7 causing severe bilateral foraminal narrowing. Electromyography showed neurogenic changes consistent with chronic C6/7 radiculopathy. There was no response to numerous medical treatments for his dystonia or brachialgia. Computed tomography-guided right C6 and C7 root block led to complete but temporary resolution of all symptoms, including the dystonic tremor. Definitive treatment consisting of a C5/6 and C6/7 anterior cervical discectomy and fusion led to a complete, immediate, and continued resolution of his right-sided brachialgia and dystonic tremor.
This case highlights the potential of cervical disc prolapse to present with dystonic tremor with the likely mechanism being secondary to the painful radiculopathy and highlights the potential benefits of surgical decompression with this atypical presentation.
据我们所知，这是首例颈椎间盘突出症合并椎间孔狭窄，除了臂痛外，还表现为张力障碍性震颤的病例报告。
一名 54 岁、右利手男性出现张力障碍性震颤和右上肢疼痛。颈椎磁共振成像显示 C5/6 处的椎间盘骨赘复合物导致双侧 C6 椎间孔受压，以及 C6/C7 处的椎间盘骨赘复合物导致双侧椎间孔严重狭窄。肌电图显示符合慢性 C6/7 神经根病的神经源性改变。他的肌张力障碍或臂痛的多种药物治疗均无反应。计算机断层扫描引导下的右侧 C6 和 C7 神经根阻滞导致所有症状（包括张力障碍性震颤）完全但暂时缓解。包括 C5/6 和 C6/7 前路颈椎间盘切除术和融合术在内的确定性治疗导致其右侧臂痛和张力障碍性震颤完全、立即和持续缓解。
本病例强调了颈椎间盘突出症表现为张力障碍性震颤的可能性，其可能的机制是继发于疼痛性神经根病，并强调了在这种非典型表现下手术减压的潜在益处。
