Sudden quadriplegia after acute cervical disc herniation.
BACKGROUND
Acute neurological deterioration secondary to cervical disc herniation not related to external trauma is very rare, with only six published reports to date. In most cases, acute symptoms were due to progression of disc herniation in the presence of pre-existing spinal canal stenosis.


METHODS
A 42-year-old man developed weakness and numbness in his arms and legs immediately following a sneeze. On physical examination he had upper motor neuron signs that progressed over a few hours to a complete C5 quadriplegia. An emergent magnetic resonance imaging study revealed a massive C4/5 disc herniation. He underwent emergency anterior cervical discectomy and fusion. Postoperatively, the patient remained quadriplegic. Eighteen days later, while receiving rehabilitation therapy, he expired secondary to a pulmonary embolus. Autopsy confirmed complete surgical decompression of the spinal cord.


CONCLUSIONS
Our case demonstrates that acute quadriplegia secondary to cervical disc herniation may occur without a history of myelopathy or spinal canal stenosis after an event as benign as a sneeze.
Sadanand
Venkatraman
V
Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Kelly
Michael
M
Varughese
George
G
Fourney
Daryl R
DR
D000328:Adult; D017809:Fatal Outcome; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D011655:Pulmonary Embolism / Q000150:complications; D011782:Quadriplegia / Q000209:etiology* / Q000473:pathology; D013919:Thromboangiitis Obliterans / Q000150:complications