Myelopathy Due to Occult Trauma Mimicking Transverse Myelitis

Traumatic myelopathy is thought to be an obvious diagnosis. However, trauma may not be obvious, and the resultant lesion can resemble transverse myelitis. Here we describe the case of a 16-year-old female that presented with subacute distal sensory changes progressing to quadriparesis with prominent upper motor neuron signs. MRI revealed an enhancing lesion in the cervical cord with moderate degenerative changes in discs and vertebrae. Workup did not show evidence of infection or inflammation on both serum and cerebrospinal fluid (CSF). Despite empirical treatment with high-dose steroids and plasma exchange (PE), the patient continued to worsen. Subsequently, a long history of a motor tics involving her neck causing repetitive low-grade trauma to her spinal cord was identified. Dynamic MRI showed cervical spine compression on neck extension. After surgical decompression, the patient neurologically stabilized, and her neuropathic pain improved.