Saturday Night Myelopathy: Flexion Myelopathy Related to Drug Intoxication.

Introduction: Myelopathy is a common condition with a variety of causes, often eluding diagnosis for some time. Prolonged flexion after surgical procedures has been described.

Case Report: A 20-year-old female presented with acute paraparesis after polysubstance drug intoxication and a period of prolonged neck flexion while unconscious. Imaging demonstrated extensive cervicothoracic central cord signal change, in addition to posterior neck musculature hyperintensity. Additional workup directed to other causes was negative. The patient was diagnosed with flexion myelopathy and was treated with a course of steroids, with marked improvement.

Conclusions: The clinician should consider the possibility of flexion-related myelopathy particularly in cases of drug intoxication or prolonged unconsciousness. Signal change within cervical musculature may provide additional clues and allow diagnosis in a timely manner.