Cervical Metastases Mimicking Ulnar Neuropathy in a 78-Year-Old Man With Advanced Oesophageal Squamous Cell Carcinoma

Metastatic spinal cord compression (MSCC) can present with subtle or atypical neurological deficits and may be mistaken for peripheral neuropathy. We report the case of a 78-year-old man with recurrent metastatic mid-oesophageal squamous cell carcinoma who was admitted with community-acquired pneumonia and hypoxia. During his admission, he developed numbness in the fourth and fifth digits of the left hand, which progressed over 48 hours to weakness and clawing of the hand. Neurological examination demonstrated an ulnar-claw posture with severe intrinsic hand weakness, preserved proximal strength, intact cranial nerves, no identifiable sensory level, and no upper motor neuron signs. Apart from weakness predominantly affecting the ulnar nerve distribution, there were no other focal lower motor neuron findings. Magnetic resonance imaging (MRI) of the whole spine revealed extensive metastatic disease involving the cervical vertebrae (C4-C7), including a pathological fracture at C7, spinal canal stenosis, and left-sided neuroforaminal involvement at C6-C7 corresponding to the patient's neurological deficits. Given his frailty and limited prognosis, he was managed conservatively with corticosteroids, cervical immobilisation, and palliative radiotherapy. This case highlights the risk of diagnostic anchoring on peripheral causes and emphasises the importance of early spinal imaging in patients with cancer who present with new focal neurological deficits, even in the absence of pain or upper motor neuron signs.