Limb myorhythmia from spinal cord glioma

A 26-year-old man gave a 4-week history of involuntary movements in the right arm (figure 1), manifesting as slow rhythmic, painless spasms of abduction. He had been previously well. On examination, he had generalised hyperreflexia with bilateral extensor plantar responses. MR scan of the brain, electroencephalogram and nerve conduction studies were normal. Needle electromyography identified bursts of involuntary motor unit activity with an average duration of around 1000 ms (1 Hz) in the right deltoid, biceps and pronator teres muscles. MR scan of cervical spine identified a spinal cord tumefactive lesion at C5–C6 vertebral levels, sparing only the left lateral aspect of the spinal cord, suggesting an intramedullary tumour (figure 2A,B). Following surgical resection, his movements completely resolved. Neuropathology confirmed the lesion to be a spinal cord glioma; immunohistochemistry showed expression of glial fibrillar acidic protein and Ki-67, a nuclear proliferation marker, suggesting it was of a…

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