Progressive Hemiparesis Due to Cervical Ossification of the Ligamentum Flavum Resembling Stroke: A Case Report

Ossification of the ligamentum flavum (OLF) predominantly affects the thoracic spine; cervical involvement is rare and often underrecognized, typically progressing slowly with motor or sensory symptoms. Here, the authors present a 70-year-old male who has experienced a subacute progression of hemiparesis, which is atypical for OLF and could easily be misdiagnosed as a stroke attack, attributed to OLF that resolved following a laminectomy. A 70-year-old man with diabetes mellitus developed initial bilateral upper limb numbness, followed by progressive left upper and lower extremity weakness over 1 month. Initial stroke suspicion was negated by normal brain imaging. A cervical magnetic resonance imaging revealed ossified lesions at C5-C6 with posterior spinal cord compression. Cervical laminectomy was performed, and pathological examination confirmed OLF. Neurological symptoms improved steadily following surgery and rehabilitation. Cervical OLF may cause severe hemiparesis in such a short period of time, presenting in an atypical manner for its nature and may resemble cerebrovascular disease. Accurate and timely diagnosis is essential to prevent permanent neurological deficit through appropriate surgical decompression, such as laminectomy.