Cervical spondylotic myelopathy (CSM) is the most common nontraumatic spinal cord condition in people over 55 years of age. This disorder is due to compression of the spinal cord by a stenotic cervical canal. A 55-year-old hypertensive patient with a clinical picture that simulated a stroke is described, due to a sudden onset of a right brachiocrural motor deficit, with elevated blood pressure levels in the range of hypertensive crisis. Hours later the patient presented the same motor deficit contralaterally: Computed tomography and magnetic resonance imaging of the brain showed no abnormality. The finding of atrophy in the interosseous muscles was striking. Cervical magnetic resonance imaging was performed showing a narrow spinal canal, with spinal cord hyperintensity in T2 sequences at levels C2 to C6. The most frequent causes of stroke mimics are tumors and metabolic toxic disorders. Spinal disorders represent 1.7% of all cases, CSM being a rare cause.

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