1116 - When Weakness isn’t What it Seems: Delayed Diagnosis of a Cervical Intramedullary Tumor - a Case Report

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

HD

Hannah Dykxhoorn, BS

Medical Student
University of Miami Miller School of Medicine
Miami, Florida, United States
ZP

Zackary T. Park, MD

Resident Physician
University of Miami/Jackson Memorial Hospital
Miami, Florida, United States

Co-Author(s)

MA

Matison Alderman, MD

PGY4 Resident, Chief
University of Miami Miller School of Medicine/ Jackson Health System
Miami, Florida, United States
JV

Jose Vives-Alvarado, MD

Attending Physician
University of Miami
Miami, Florida, United States

Submitter(s)

ZP

Zackary T. Park, MD

University of Miami/Jackson Memorial Hospital
Miami, Florida, United States

Case Diagnosis: Cervical intramedullary low-grade glioma

Case Description: A 21-year-old male presented with progressive bilateral upper extremity weakness and hand atrophy over 4 years. Early evaluations suggested peripheral nerve pathology, and electromyography and nerve conduction studies showed bilateral ulnar nerve compression. Based on these findings, he underwent left ulnar nerve decompression, and subsequent right ulnar nerve decompression. Despite both surgeries and occupational therapy, his upper extremity weakness, hand atrophy, and fine motor skills continued to worsen. Over a year after the decompressions, his ongoing neurologic deficits prompted further evaluation. A cervical MRI revealed a large intradural intramedullary lesion extending from C3-T1 with cord expansion, minimal enhancement, and associated syrinx. The patient subsequently underwent C3–C7 left laminoplasty with intradural tumor resection, confirmed as a low-grade glioma, and was transferred to inpatient rehabilitation. At discharge, he demonstrated improvements in mobility, transfers, and gait with reduced assistance, and was deemed safe to return home with plans for outpatient therapy.

Discussions: This case highlights the importance of thorough neurologic evaluation, including imaging, in patients with progressive upper extremity weakness and hand atrophy. Reliance on peripheral nerve studies alone can delay diagnosis, as shown by repeated ulnar nerve decompressions. Persistent or worsening symptoms should prompt consideration of peripheral nerve pathology, cervical spine lesions, demyelinating disorders, and tumors. Early imaging and comprehensive evaluation are critical to identify structural causes, guide surgical planning, and prevent prolonged functional decline. In addition, inpatient rehabilitation was essential, enabling the patient to regain meaningful functional mobility, achieve safe family-assisted transfers, and transition successfully to outpatient therapy.

Conclusions: Progressive upper extremity deficits warrant early, comprehensive evaluation, including advanced imaging, to detect structural or central causes and guide timely intervention, minimizing functional decline and unnecessary procedures.