Abstract
•The importance of pre-operative neurophysiological baseline check to detect intra-operative abnormalities.•Proper neck positioning based on the size and location of intra-spinal tumors.•Intra-tumoral hemorrhage may lead to baseline neurophysiological changes in conjunction with improper neck positioning.
Cervical spine schwannomas are uncommon. Sudden onset quadriparesis has been reported in cases of acute hemorrhage within cervical spine schwannoma; however, no such case was found in the literature describing quadriplegia as a result of neck manipulation. We present a case of a sudden onset, temporary loss of SSEP and MEP due to positional neck changes.
Case presentation: A 29-year-old male patient presented with a three days onset right-sided weakness progressing to the left side with an associated fecal and urinary incontinence a few days. MRI with and without contrast for the brain and the whole spine was done and it revealed an IDEM lesion at C2-C4 that is iso to hyper-intense on T2 with avid contrast enhancement on T1. While preparing the patient for surgery and during positioning, SSEP and MEP signals were lost and subsequently restored when the neck was positioned with a mild extension. Laminectomy of the C2-C3-C4 levels was done, and the tumor was completely resected. Frozen section revealed a diagnosis of schwannoma. Post-operatively, the patient improved significantly and gained his motor and sensory functions.
Sudden Loss of MEP and SSEP signals with neck positioning in an IDEM lesion is uncommon. We hypothesize that positional changes in the cervical spine lead to continuous and aggravated pressure on the spinal cord, albeit temporary. Manipulating the neck to its original position can decompress the spinal cord and restore the original neurophysiological status.