Delayed diffuse upper motor neuron syndrome after compressive thoracic myelopathy

A 54-year-old man developed progressive spastic paraparesis beginning 2 wee ks after a back injury caused by a subacute compressive thoracic myelopathy attributable to a post-traumatic arachnoid cyst. Three to 18 months after surgical decompression of the thoracic arachnoid cyst, the patient develope d a diffuse predominantly upper motor neuron syndrome characterized by spas tic quadriparesis, pseudobulbar paresis, and pseudobulbar affect. Retrograd e corticospinal tract degeneration and upper motor neuron death after spina l cord injury is recognized. This case suggests that focal upper motor neur on injury can occasionally precipitate diffuse upper motor neuron dysfuncti on.