Clinical Practice and Cases in Emergency Medicine

Introduction: Ewing sarcoma is a relatively common neoplasm occurring in pediatric patients 10-20 years of age, commonly presenting with bone fracture, fever, and pain and swelling at the site of the primary tumor. Here we present an unusual case of Ewing sarcoma in the cervical spine leading to neurological symptoms including left lower extremity hemiparesis and left upper extremity hemiplegia.

Case Report: A 19-year-old Bengali-speaking male presented to the emergency department with a three-week history of left lower extremity hemiparesis and left upper extremity hemiplegia. Due to concern for spinal cord compression, a computed tomography of the cervical spine without contrast was obtained, which revealed a lucent lesion in the left fifth cervical (C5) vertebral body. Magnetic resonance imaging of the cervical spine revealed a left cervical extradural mass present from C3-C7. The patient subsequently underwent C3-C7 laminectomy with tumor decompression and fusion one week later. Surgical pathology revealed Ewing sarcoma. Following chemotherapy two months later the patient
regained complete recovery of motor and sensory function in the left lower and left upper extremities.

Conclusion: It is important for emergency physicians to broaden their differential diagnosis when the physical examination reveals neurological deficits as exhibited in this case. A broader workup must be obtained that does not solely consist of head imaging but also includes imaging of the spine to prevent missing the diagnosis.