Writer’s Cramp as a Manifestation of Cervical Demyelinating Lesions

(online suppl. video, www.karger.com/ doi/10.1159/000102169). Sensory examination showed hypesthesia of the right hand, most likely corresponding to segments C7 and C8. The muscle tone was normal at rest. The deep tendon reflexes in both extremities were symmetric and normoactive. Slit-lamp examination excluded Kayser-Fleischer rings. An initial MRI scan of the brain and cervical spine showed focal demyelinating lesions involving the periventricular white matter and spinal cord segments C6 and C7 ( fig. 1 a–c). The results of our routine investigations, including hematological and biochemical screening, autoimmune profile, and measurements of the serum ceruloplasmin and copper and urine copper levels, were all normal. The cerebrospinal fluid studies including oligoclonal band and myelin basic protein were also normal. In addition, electrophysiological studies did not demonstrate any abnormalities. Three months later follow-up MRI of the brain showed enhancing plaques at subcortical white matter areas ( fig. 1 d).