Myelopathy secondary to a spinal cord compression induced by C2 nerve tumors during head rotation

It is well known that nerve root tumors developing in the spinal canal can be responsible for spinal cord compression leading to myelopathy and neurological deficits. We report the case of a patient with bilateral C2 neurofibromas presenting with a myelopathy of the upper cervical spine with no spinal cord compression on standard magnetic resonance imaging. The spinal cord compression occurred between the cervical neurofibromas only during head rotation.

A patient with bilateral neurofibromas of the C2 nerve roots showed a progressive neurological deterioration with an intramedullary MRI hypersignal without visible compression. Only an additional MRI carried-out with the head in rotation demonstrated the tumoral dynamic compression. A review of the literature showed that only two similar cases had previously been reported. The largest C2 tumor was completely removed uneventfully.

Dynamic compression of the spinal cord in patients with bilateral C2 nerve root tumors must be routinely investigated even if the standard MRI shows no compression.