# Recurrent myelitis secondary to peripheral nerve root stretching: A case report and review of the literature

## TL;DR

A 55-year-old man developed recurring nerve issues in his left arm after weightlifting, possibly due to nerve stretching and muscle mass reduction.

## Contribution

This case report highlights a rare presentation of recurrent myelitis and peripheral neuritis linked to nerve root stretching during physical activity.

## Key findings

- The patient's symptoms improved temporarily but recurred during daily activities.
- MRI ruled out cervical myelitis, suggesting a different cause for the nerve dysfunction.
- The unique case may be attributed to reduced muscle mass increasing nerve root vulnerability during weightlifting.

## Abstract

Stretching a nerve more than 5% of its resting length for an extended period can result within changes dysfunction and ischemia. Nerve damage known as neuropathy can range from minor sensory changes like tingling or numbness to more severe injuries such as paralysis. 55-year-old male without significant past medical history experienced numbness, pain, and tingling in his left arm and forearm while lifting weights. An Electromyography-Nerve Conduction Study indicated multiple active root irritations on the left side at levels C5-C8. A Magnetic Resonance Image of the cervical spine showed a hyperintense signal lesion in the area of the cervical spinal cord from C2-C5 vertebrae, ruling out cervical myelitis. His symptoms gradually improved and were relieved for approximately 5 months with minimal signs, but recurred during daily activities. This second episode has lasted 12 months with ongoing treatment. After 12 months of follow-up, his issue has diminished but remains unresolved. It is uncommon to observe peripheral or peripheral-like symptoms in patients with recurrent peripheral neuritis and myelitis affecting only the left upper extremity. The study was approved by the ethics committee of Shiraz University of Medical Sciences with the code of IR.Sums.Med.Rec.1403.154. The patient signed the written informed consent form to document this case and include the accompanying images. It is unusual to see peripheral or peripheral-like symptoms in patients experiencing recurrent myelitis and peripheral neuritis and specifically affecting the left upper extremity. The exacerbation of symptoms when lying down on the affected side and stretching nerves is also significant. This unique presentation may be attributed to the reduced muscle mass in the proximal muscles of the upper extremity, making the nerve roots more susceptible to damage during weightlifting.