The Attack of the "Fake Stroke": Paralysis Not from the Brain, but the Neck - Understanding Cervical Myelopathy

In the era of smartphone addiction, one of the most alarming issues, aside from persistent neck pain, is the 'misinterpretation of symptoms.'

Recently, a man in his 60s, referred to as Mr. A, visited a hospital after his family grew concerned that his awkward hand movements and difficulty maintaining balance while walking might indicate a stroke. However, he was diagnosed with cervical myelopathy, a relatively unfamiliar condition.

Because the early symptoms are subtle and non-specific, abnormalities in hand movement and gait can easily be mistaken for a stroke.

Pain in neck, shoulders, hands, and arms. Provided by Clipart Korea (not related to the report)

The cervical spine, which consists of seven vertebrae, supports the head and enables precise movements in various directions, including rotation, flexion and extension, and lateral bending. It also serves as the pathway for peripheral nerves that branch out to the arms, shoulders, and hands, and protects the spinal cord and neural structures that pass through the spinal canal within the cervical spine.

The spinal cord is a core structure of the central nervous system, beginning at the brain and running continuously down through the cervical, thoracic, and lumbar vertebrae. It serves as the motor pathway transmitting commands from the brain to the muscles, the sensory pathway relaying information from the body to the brain, and the center for reflex actions that enable rapid responses to stimuli.

Cervical myelopathy refers to spinal cord injury caused by compression of the spinal cord in the cervical region due to various causes. The main causes include degenerative changes in the cervical spine, cervical disc herniation (commonly known as a herniated cervical disc), ossification of the posterior longitudinal ligament, and ossification of the ligamentum flavum.

Structural changes that can lead to cervical myelopathy include cases where the intervertebral disc, which acts as a shock absorber between the vertebrae, herniates and directly compresses the spinal cord; when the posterior longitudinal ligament located behind the vertebral body thickens or ossifies, narrowing the space for the spinal cord; and when the ligamentum flavum, which connects the vertebral arches, becomes thickened or ossified, compressing the spinal cord from the back.

In the early stages, pain and tingling in the neck, shoulders, hands, and arms may occur, which can be mistaken for a herniated cervical disc. As spinal cord compression worsens, fine motor impairment in the hands may develop, leading to decreased ability to use chopsticks or write, and making it difficult to fasten buttons or grasp objects.

Gait disturbances may also occur, with a narrower stride and difficulty maintaining balance, making it hard to go up or down stairs. If left untreated, it can progress to severe neurological deficits such as urinary dysfunction and significant gait impairment.

Jung Dongmun, Director of the Spine Center at Daedong Hospital and a neurosurgeon, emphasized, "While herniated cervical discs are widely known in modern society, cervical myelopathy is relatively unfamiliar, and its early symptoms are subtle and non-specific, so it is often mistaken for simple aging or neglected. In particular, symptoms such as clumsy hand movements and unstable gait are similar to those of a stroke, which can delay early diagnosis, so caution is needed."

He further advised, "Spinal cord injury can cause various neurological deficits depending on the location and extent of the damage, and once nerve function is impaired, recovery is often limited. Therefore, accurate early diagnosis and appropriate treatment are extremely important."

Diagnosis involves physical examination, MRI, CT, and X-rays to assess the degree of spinal cord compression, disc changes, and spinal alignment, with additional neurological tests performed as needed.

Depending on the diagnosis, conservative treatments such as medication and physical therapy are initially applied. If spinal cord compression is severe or progressive neurological deficits are present, surgical treatment is considered.

To prevent cervical myelopathy, it is important to maintain proper posture that aligns the spine during daily activities such as prolonged computer or smartphone use and driving, to regularly perform stretching and exercises to strengthen the neck, shoulder, and back muscles, and to manage an appropriate weight to reduce the burden on the spine.

If you experience any of the following symptoms: difficulty with precise hand movements such as using chopsticks or fastening buttons; inability to quickly make a fist and open your hand 20 times in 10 seconds; tingling in both arms and legs; weakness in the legs; unstable gait; tingling or aching at the fingertips; pain in the neck or shoulder area; or difficulty moving your arms, it is advisable to visit a medical institution to check your condition. For those aged 50 and older, when aging and degenerative changes progress, regular spinal evaluations are recommended.

This content was produced with the assistance of AI translation services.