Myelopathic motor symptoms overlaying Parkinson's disease

Parkinson's disease (PD) may increase the risk of degenerative cervical myelopathy, causing overlaying myelopathic motor symptoms that can be challenging to identify. However, this diagnosis must not be missed, given the risk of profound and lasting disability and the benefit of surgical intervention. We describe a fortnight in which three patients with PD were admitted to our inpatient movement disorders service with degenerative cervical myelopathy; each highlighting a distinct learning point regarding diagnosis or management. First, that careful examination is crucial, and clinicians should always consider degenerative cervical myelopathy in a patient with PD whose mobility has dramatically reduced. Second, patients may need pharmacological suppression of cervical dyskinesias after surgery to prevent ongoing injury and to promote healing. Third, medical factors, such as B12 deficiency, with the potential to exacerbate myelopathic effects, should be corrected.