The patient came 26-July-2012 complaining of LBP with bilateral sciatica for 1 year. Had difficult walking with ataxia for 1 week. MRI lumbar spine done 07-March-2012 showed lumbar canal stenosis L3-4 and L4-5. On examination at that time, he was limping and dragging the right lower limb. The patient was sent for further investigations and disappeared.

The patient then came 15-August-2013 with clinical deterioration and weak four limbs and difficult walking and dragging the right lower limb. The MRI of the brain requested in first visit done 17-October-2012 showed small scattered lacunar infarctions both cerebral hemispheres and the brainstem. MRI cervical spine bad quality showing cervical canal stenosis C5-6, C6-7.

On examination the patient has weak grip left hand 3/5 extension of both hands and triceps both upper limbs -4/5. Weak right quadriceps 4/5, abduction and adduction of the right knee 4/5, dorsiflexion right foot -3/5, left foot +3/5 and planterflexion right foot 4/5. SLRS was 60 degrees due to weak right lower limb and exaggerated KJ more the right.

MRI cervical spine performed 15-August-2013 showing severe cervical canal stenosis C4-5, C5-6 and C6-6 with old extruded disci C5-6, C6-7.

Decompressive laminectomy C4,C5,C6 and C7. There was no epidural fat at the exposed areas. There was slight overmobility of the segments. The lateral masses was not violated. Routine closure of the wound.

Smooth postoperative recovery.  

Cervical canal stenosis taking precedence over the lumbar canal.

As mentioned above the patient has lacunar infarctions of the brainstem and cerebral hemispheres. Surgery in this case was advised with such data to eliminate all the causes other than infarctions.