Rare cause of neck pain and gait imbalance: a case report

Authors

  • Isam Sami Moghamis Department of Orthopaedics Surgery, Hamad Medical Corporation, Doha, Qatar
  • Jawad Derbas Qatar University, College of Medicine, QU Health, Doha, Qatar
  • Amgad M. Elshoeibi Qatar University, College of Medicine, QU Health, Doha, Qatar
  • Alaa Daher Department of Orthopaedics Surgery, Hamad Medical Corporation, Doha, Qatar
  • Mohamed Ali AlHabash Department of Orthopaedics Surgery, Hamad Medical Corporation, Doha, Qatar
  • Ahmad Shihab Al Tabouki Department of Neurology, Hamad Medical Corporation, Doha, Qatar
  • Abdulmoeen Baco Department of Orthopaedics Surgery, Hamad Medical Corporation, Doha, Qatar

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251145

Keywords:

Chronic inflammatory demyelinating polyradiculoneuropathy, Neurological deficit, Neck pain, Weakness, Imbalance

Abstract

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an uncommon cause of neck pain and radiculopathy that can be easily misdiagnosed. The lack of diagnostic criteria makes the diagnosis of such cases challenging. However, the correlation between clinical presentation with laboratory and radiological findings can help diagnose these patients. Surgical decompression is rarely indicated in the absence of any cause of neuronal compression. Medical treatment of CIDP is currently the main line of treatment. We are presenting a case of a 32-year-old male with no known medical conditions who presented to our spine clinic with a history of chronic neck pain associated with gradual and progressive left upper limb weakness and imbalance. Clinical imaging showed hypertrophied nerve roots of the cervical spine. The patient was treated with intravenous immunoglobulins and corticosteroids, which improved his symptoms significantly.

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References

Tan JC, Burns DL, Jones HR. Severe ataxia, myelopathy, and peripheral neuropathy due to acquired copper deficiency in a patient with history of gastrectomy. JPEN J Parenter Enteral Nutr. 2006;30(5):446–50. DOI: https://doi.org/10.1177/0148607106030005446

Mehndiratta MM, Gulati NS. Central and peripheral demyelination. J Neurosci Rural Prac. 2014;5(01):84–6. DOI: https://doi.org/10.4103/0976-3147.127887

Koros C, Evangelopoulos ME, Kilidireas C, Andreadou E. Central Nervous System Demyelination in a Charcot-Marie-Tooth Type 1A Patient. Case Reports Neurol Med. 2013;2:1–4. DOI: https://doi.org/10.1155/2013/243652

Moghamis IS, Alamlih MI, Alhardallo MA, Al Hyassat S, Abdelsalam S, Baco A. Rare presentation of intra-spinal extradural grade 1 chondrosarcoma: A case report. Int J Surg Case Reports. 2022;94:106985. DOI: https://doi.org/10.1016/j.ijscr.2022.106985

Moghamis IS, El Ansari W, Abdelsalam S, Baco AM. First case of mechanical compression by methylprednisolone crystals following transforaminal lumbar nerve root block for left sciatic pain leading to hyperesthesia and progressive weakness: A case report. Int J Surg Open. 2021;34:100364. DOI: https://doi.org/10.1016/j.ijso.2021.100364

Chang MC. Missed diagnosis of chronic inflammatory demyelinating polyneuropathy in a patient with cervical myelopathy due to ossification of posterior longitudinal ligament. Neurol Int. 2018;10(3):7690. DOI: https://doi.org/10.4081/ni.2018.7690

Chung T, Prasad K, Lloyd TE. Peripheral Neuropathy. Neuroimaging Clin North America. 2014;24(1):49–65. DOI: https://doi.org/10.1016/j.nic.2013.03.023

Joint Task Force of the EFNS and the PNS. European federation of neurological societies/peripheral nerve society guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint task force of the European federation of neurological societies and the peripheral nerve society - first revision. J Peripheral Nervous System. 2010;15(1):1–9. DOI: https://doi.org/10.1111/j.1529-8027.2010.00245.x

Lewis RA. Chronic inflammatory demyelinating polyneuropathy. Current Opinion in Neurology. 2017;30(5):508–12. DOI: https://doi.org/10.1097/WCO.0000000000000481

10. Gorson KC, Gooch CL. The (mis)diagnosis of CIDP: The high price of missing the mark. Neurol. 2015;85(6):488–9. DOI: https://doi.org/10.1212/WNL.0000000000001838

Barohn RJ. Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Clinical Characteristics, Course, and Recommendations for Diagnostic Criteria. Arch Neurol. 1989;46(8):878. DOI: https://doi.org/10.1001/archneur.1989.00520440064022

Koski CL, Baumgarten M, Magder LS, Barohn RJ, Goldstein J, Graves M, et al. Derivation and validation of diagnostic criteria for chronic inflammatory demyelinating polyneuropathy. J Neurolog Sci. 2009;277(1–2):1–8. DOI: https://doi.org/10.1016/j.jns.2008.11.015

Report from an Ad Hoc Subcommittee of the American Academy of Neurology AIDS Task Force. Research criteria for diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). Neurol. 1991;41(5):617–8. DOI: https://doi.org/10.1212/WNL.41.5.617

Schady W, Goulding PJ, Lecky BR, King RH, Smith CM. Massive nerve root enlargement in chronic inflammatory demyelinating polyneuropathy. J Neurol Neurosurg Psych. 1996;61(6):636–40. DOI: https://doi.org/10.1136/jnnp.61.6.636

Bril V, Blanchette CM, Noone JM, Runken MC, Gelinas D, Russell JW. The dilemma of diabetes in chronic inflammatory demyelinating polyneuropathy. J Comp. 2016;30(7):1401–7. DOI: https://doi.org/10.1016/j.jdiacomp.2016.05.007

Rajabally YA, Stettner M, Kieseier BC, Hartung HP, Malik RA. CIDP and other inflammatory neuropathies in diabetes — diagnosis and management. Nat Rev Neurol. 2017;13(10):599–611. DOI: https://doi.org/10.1038/nrneurol.2017.123

Tracy JA, B Dyck PJ. Investigations and treatment of chronic inflammatory demyelinating polyradiculoneuropathy and other inflammatory demyelinating polyneuropathies: Current Opinion Neurol. 2010;23(3):242–8. DOI: https://doi.org/10.1097/WCO.0b013e3283394203

Maria Villa A, Garcea O, Di Egidio M, Saizar R, Pedro Sica RE. Interferon beta-1a in chronic inflammatory demyelinating polyneuropathy: case report. Arq Neuro-Psiquiatr. 2004;62(3b):892–4. DOI: https://doi.org/10.1590/S0004-282X2004000500031

Dyck PJ, O’Brien PC, Oviatt KF, Dinapoli RP, Daube JR, Bartleson JD, et al. Prednisone improves chronic inflammatory demyelinating polyradiculoneuropathy more than no treatment. Ann Neurol. 1982;11(2):136–41. DOI: https://doi.org/10.1002/ana.410110205

Van Schaik I, Winer J, De Haan R, Vermeulen M. Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculo-neuropathy. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd. 2002: 1797. DOI: https://doi.org/10.1002/14651858.CD001797

Hughes RA, Mehndiratta MM, Rajabally YA. Corticosteroids for chronic inflammatory demyelinating polyradiculoneuropathy. Cochrane Neuromuscular Group, editor. Cochrane Database Systematic Reviews. 2019;10:778. DOI: https://doi.org/10.1002/14651858.CD002062.pub4

Dyck PJ, Daube J, O’Brien P, Pineda A, Low PA, Windebank AJ, et al. Plasma exchange in chronic inflammatory demyelinating polyradiculo-neuropathy. N Engl J Med. 1986;314(8):461–5. DOI: https://doi.org/10.1056/NEJM198602203140801

Dyck PJ, Pineda A, Swanson C, Low P, Windebank A, Daube J. The Mayo Clinic experience with plasma exchange in chronic inflammatory-demyelinating polyneuropathy (CIDP). Prog Clin Biol Res. 1982;106:197–204.

Rigal J, Quarto E, Boue L, Balabaud L, Thompson W, Cloché T, et al. Original surgical treatment and long-term follow-up for chronic inflammatory demyelinating polyradiculoneuropathy causing a compressive cervical myelopathy: review of the Literature. Neurospine. 2022;19(2):472–7. DOI: https://doi.org/10.14245/ns.2143232.616

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Published

2025-04-25

How to Cite

Moghamis, I. S., Derbas, J., Elshoeibi, A. M., Daher, A., AlHabash, M. A., Tabouki, A. S. A., & Baco, A. (2025). Rare cause of neck pain and gait imbalance: a case report. International Journal of Research in Orthopaedics, 11(3), 620–623. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251145

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Section

Case Reports