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Cervical flexion myelopathy after valproic acid overdose
K L Kaye1, D Ramsay, G B Young
1Departments of Clinical Neurological Sciences and Pathology, London Health Sciences Centre, London, Ontario, Canada.
Spine
|November 8, 2001
Summary
Prolonged extreme neck flexion can cause severe cervical myelopathy, especially with muscle relaxation. This case highlights a medication overdose as a cause, with detailed clinical and pathological findings.
Area of Science:
- Neurology
- Neurosurgery
- Pathology
Background:
- Cervical myelopathy has been reported after intraoperative and forced neck flexion.
- This study presents the first case of cervical flexion myelopathy following a medication overdose.
Observation:
- A 25-year-old woman developed transverse myelopathy at C6 after a valproic acid overdose.
- She was found in extreme neck flexion for approximately 18 hours.
- Imaging revealed cervical cord enlargement and paraspinal swelling.
Findings:
- Pathology confirmed transverse spinal cord necrosis at C6 with central gray matter necrosis.
- The patient died from pulmonary embolism and pneumonia.
Implications:
- Prolonged extreme neck flexion with muscle relaxation can lead to severe myelopathy.
- Compromised spinal cord microcirculation is a likely contributing factor.
- This case provides a crucial clinical-pathologic correlation for cervical flexion myelopathy.