Teaching NeuroImage: Fluorosis: A Forgotten Cause of Compressive Myelopathy

A 26-year-old man having restricted neck movements for 4 years developed progressive quadriplegia with bladder-bowel involvement over 15 days. His parents and local village residents reported similar symptoms. Hemogram and biochemistry (including vitamin D) analysis were normal. X-ray bilateral forearm showed interosseous membrane calcification (Figure 1). Bone densitometry at distal radius showed a Z score of –2.5. MRI cervicodorsal spine revealed multilevel disco-osteophytic complexes at C3-C4 and C6-C7 with ossified ligatum flavum causing cord compression (Figure 2). Excess drinking water fluoride causes osteoblast and osteoclast activation resulting in periosseous tissue ossification and immature bone deposition. Sclerosed ligaments/osteophytes due to fluorosis can cause compressive myelopathy in endemic areas.1,2

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