Sensory ataxia-plus secondary to cervical spondylotic myelopathy

A 45-year-old male patient presented a 2-week history of progressive gait imbalance. He also presented impaired proprioception, symmetric distal quadriparesis (grade 4/5), gait ataxia with a positive Romberg sign, bilateral upper limb dysmetria, and dysdiadochokinesia. The patient did not present nystagmus and/or dysarthria. A cervical spine magnetic resonance imaging (MRI) scan revealed severe degenerative disk disease and compressive spondylotic myelopathy at C3-C4 and C5-C6 ( Figure 1A ). He was submitted to posterior decompression and laminoplasty involving C3-C7 ( Figure 1B ), and presented improvement in gait. Mild cerebellar signs in a patient with a positive Romberg sign, without dysarthria and nystagmus, point to a sensory ataxia-plus rather than a cerebellar etiology. ^{1 2}

Figure 1.

Cervical spinal cord T2-weighted MRI revealing severe degenerative disk disease and compressive spondylotic myelopathy at the levels of C3-C4 and C5-C6 ( A ). Cervical spinal cord T2-weighted MRI showing signs of posterior cervical decompression and cervical laminoplasty involving C3-C7 ( B ).