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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1810425
Case Report

Progressive Hemiparesis Due to Cervical Ossification of the Ligamentum Flavum Resembling Stroke: A Case Report

Minami Saura
1   Department of Neurosurgery, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki, Japan
,
Kiyoyuki Yanaka
1   Department of Neurosurgery, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki, Japan
,
Toshihide Takahashi 
1   Department of Neurosurgery, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki, Japan
,
Sho Hanai 
1   Department of Neurosurgery, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki, Japan
2   Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki, Japan
,
Hitoshi Aiyama
1   Department of Neurosurgery, Tsukuba Memorial Hospital, Kaname, Tsukuba, Ibaraki, Japan
,
Noriaki Sakamoto
3   Diagnostic Pathology, Institute of Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki, Japan
,
Eiichi Ishikawa
2   Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki, Japan
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Abstract

Ossification of the ligamentum flavum (OLF) predominantly affects the thoracic spine; cervical involvement is rare and often underrecognized, typically progressing slowly with motor or sensory symptoms. Here, the authors present a 70-year-old male who has experienced a subacute progression of hemiparesis, which is atypical for OLF and could easily be misdiagnosed as a stroke attack, attributed to OLF that resolved following a laminectomy. A 70-year-old man with diabetes mellitus developed initial bilateral upper limb numbness, followed by progressive left upper and lower extremity weakness over 1 month. Initial stroke suspicion was negated by normal brain imaging. A cervical magnetic resonance imaging revealed ossified lesions at C5–C6 with posterior spinal cord compression. Cervical laminectomy was performed, and pathological examination confirmed OLF. Neurological symptoms improved steadily following surgery and rehabilitation. Cervical OLF may cause severe hemiparesis in such a short period of time, presenting in an atypical manner for its nature and may resemble cerebrovascular disease. Accurate and timely diagnosis is essential to prevent permanent neurological deficit through appropriate surgical decompression, such as laminectomy.

Keywords

cervical lesion - hemiparesis - laminectomy - ligamentum flavum - ossification

Authors' Contributions

M.S. served as the main author of the manuscript. K.Y. contributed to revisions and acted as a supervisor. T.T., H.A., S.H., and N.S. provided advisory support throughout the process. E.I. was involved in both revisions and supervision, in addition to serving as an advisor.




Publikationsverlauf

Artikel online veröffentlicht:
18. August 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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