Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Lucas Thibodaux, OMS-II; Stephanie Aldret, DO, CAQSM, FAOASM VCOM-Louisiana 64 RELAPSE OF UPPER EXTREMITY RADICULOPATHY FOLLOWING ANTERIOR CERVICAL DISCECTOMY AND FUSION: A CASE OF SUSPECTED ADJACENT SEGMENT DISEASE

Lydia Ta, BS 1 ; Sabeen Wazir, BS 1 ; Grace Lee 1 , BS; Ariel Antezana, MD, FAAN 2 1 VCOM-Louisiana; 2 Department of Neurology, CHRISTUS Cabrini Neuromedical Clinic of Central Louisiana, Alexandria, Louisiana 63 AN UNLIKELY CULPRIT: NEUROSARCOIDOSIS INDUCED HYPERTROPHIC MENINGITIS

Context: Hypertrophic pachymeningitis by definition is a rare form of an inflammatory disease process that includes diffuse thickening and fibrosing of the dura mater. Neurosarcoidosis is a condition characterized by granulomatous inflammation of the nervous system typically resulting from systemic sarcoidosis, leading to a wide spectrum of neurological manifestations that can affect the brain, spinal cord, cranial nerves, meninges, and peripheral nerves. Here, we present a unique case of neurosarcoidosis presenting with transverse myelitis and hypertrophic pachymeningitis in the absence of systemic sarcoidosis symptoms. Report of Case: We present a case of a 42 year old male presenting to a neurology clinic with a chief complaint of tingling and paresthesias in his upper extremities that are more pronounced with exercise. Upon conducting a neurological exam, no pertinent findings were noted other than having a mild right sided paretic gait. A thoracic spine MRI revealed longitudinally extensive transverse myelitis spanning multiple spinal levels from C7-T2. A brain MRI was conducted three months later and demonstrated generalized pachymeningeal enhancement but

with no other parenchymal abnormalities. Leading differential diagnoses (DDx) at this time included neuromyelitis optica, neurosyphilis, vasculitis, and idiopathic hypertrophic pachymeningitis. Additional testing including encephalogram (EEG) and antibody testing for HIV, syphilis, aquaporin-4 igG were normal, thus effectively ruling out the current DDx. A spinal tap was obtained for cerebral spinal fluid analysis, which ultimately revealed an ACE level of 3.2 (normal limit 0.0 2.5U/L) and a diagnosis of neurosarcoidosis. estimates unavailable due to the absence of population-based studies. Current knowledge is derived primarily from isolated case reports and small case series. The presence of HP in neurosarcoidosis has only been reported a few times and presented as a confounding factor in this patient’s diagnostic process. We hope that this patient’s case will increase the differential diagnoses for patients presenting with pachymeningitis and provide more data to the current limited body of literature on the phenomenon of HP. Conclusion: Hypertrophic pachymeningitis (HP) is exceedingly rare, with incidence

Context: Anterior Cervical Discectomy and Fusion can lead to long-term complications due to increased stress on adjacent vertebral segments resulting from loss of motion at the fused levels. These biomechanical changes may negatively impact patients’ outcomes years after surgery. Report of Case: A 59-year-old male presented with pain of his upper chest and shoulder region after cutting down trees in his yard. He also noted weakness of his left arm and hand predominantly affecting his 4th and 5th digits. He had a history of an anterior cervical disc fusion (ACDF) at C5-C7 in 2021 due to C5-C7 disc herniations and facet arthropathy. Prior to his surgery, he experienced left upper extremity pain associated with numbness and tingling radiating to the elbow with progressive weakness. Following ACDF, his symptoms significantly improved, and pain resolved until he was using a pole saw in his yard. Physical exam was unremarkable except for weakness of left elbow flexion and left-hand intrinsic muscles, most notable in his 4th and 5th digits. All other strength testing was 5/5, equal and symmetrical bilaterally. Decreased sensation was noted

over his left medial biceps and forearm. Upper extremity deep tendon reflexes (DTRs) were 2/4 and symmetrical at C5 and C7. C6 DTRs were absent 0/4 bilaterally. Hoffman’s was negative on both hands. Initial MRI of his cervical spine from 2021 showed C2-C7disc bulges without central canal narrowing, most significant from C4-C7. Mild facet arthropathy with osteophytic spurring was noted to cause left foraminal narrowing at C4-C6 and bilateral foraminal narrowing at C6-C7. His most recent MRI now shows C7 disc desiccation and partial effacement of CSF anterior to cord, as well as disc bulging of C3 C5 and C7–T3. Based on these findings, his current diagnosis is C8-T3 radiculopathy likely secondary to adjacent segment disease (ASD) following C5-C7 ACDF. ASD is also noted above the ACDF from C3-C5. During his current flare, he was treated with oral and intramuscular corticosteroids and then cervical epidural steroid injection (ESI). He will return to the pain management specialist two weeks after the ESI to observe the symptoms and see if surgery is needed in the future.

after the original ACDF procedure. ASD can result in numbness or weakness of the muscles in the neck area, resulting in the patient having difficulty changing positions, which can be quite debilitating. As the disease advances, the patient will require another surgery, which can occur approximately 32 months from the previous surgery, but can occur from 3-10 years after the original procedure.

Conclusion: Adjacent Segment Disease (ASD) can be a complication that appears many years

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2026 Research Recognition Day