Osteoarthrosis causing altered mental status: a case report

Yogesh N V Reddy, Richard A Josephson

Cervical spondylosis as a cause of diaphragmatic weakness is an uncommon entity and has been reported primarily in the setting of cervical spinal cord compression. Cervical spondylosis most often causes respiratory failure from cervical myelopathy and damage to the ventral horn cells at spinal cord segments C3 to C5 from where the phrenic nerve arises. The manifestations are variable but there may be evidence of upper motor neuron signs and neurological deficits in the lower extremities along with Lhermitte's sign. Here we report a rare case of cervical spondylosis causing phrenic nerve root compression from foraminal narrowing at C3, C4 and C5, leading to lower motor neuron paralysis of the phrenic nerve and respiratory failure, in the absence of spinal cord involvement.