Acute ptotic myelopathy: cervical compressive myelopathy resulting from prolonged head ptosis after alcohol intoxication

Clinical Medicine, 2023 · DOI: 10.7861/clinmed.2023-0294 · Published: September 1, 2023

Spinal Cord Injury Mental Health Neurology

Simple Explanation

A young man experienced sudden weakness in his limbs after a night of heavy drinking where he slept with his head slumped on his chest. Imaging revealed compression of the spinal cord in his neck, and he was diagnosed with acute dropped head syndrome linked to the prolonged awkward neck posture. The patient underwent surgery to stabilize his cervical spine and received rehabilitation, showing improvement, but later developed some residual weakness and muscle twitching.

Study Duration

Not specified

Participants

A 28-year-old man

Evidence Level

Level 4; Case Report

Key Findings

1
Prolonged neck flexion due to alcohol intoxication can lead to acute compressive cervical myelopathy.
2
The patient developed rhabdomyolysis and cervical paraspinal muscle hyperintensities along with myelopathy.
3
Surgical cervical spine fixation is the cornerstone of treatment, but additional complications should be recognised and treated.

Research Summary

This case report describes a rare instance of acute cervical myelopathy resulting from prolonged head ptosis following alcohol intoxication, termed ‘acute ptotic myelopathy.’ The patient experienced quadriparesis and rhabdomyolysis, with MRI findings indicating cervical cord compression and paraspinal muscle injury. The condition is likened to ‘toilet seat neuropathy’ due to the prolonged compressive posture and highlights the importance of recognizing and treating the complications associated with this syndrome, including alcohol use disorder.

Practical Implications

Awareness of Acute Ptotic Myelopathy

Clinicians should be aware of acute ptotic myelopathy as a potential complication of alcohol intoxication and prolonged neck flexion.

Early Diagnosis and Intervention

Early diagnosis through MRI and prompt surgical intervention can improve patient outcomes.

Alcohol Rehabilitation

Patients presenting with acute ptotic myelopathy should be evaluated for alcohol use disorder and offered rehabilitation services.

Study Limitations

1
Single case report limits generalizability.
2
Lack of detailed follow-up data.
3
Causation between alcohol intoxication and myelopathy is inferred but not definitively proven.

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