Cervical Radiculopathy Does Not Cause Syncope
Severe cervical radiculopathy does not cause syncope. Cervical radiculopathy is characterized by nerve root compression or irritation that produces neck and arm pain, sensory loss, motor dysfunction, and reflex changes in a specific dermatomal distribution of the upper extremity 1, 2. Syncope is not a recognized manifestation of this condition.
Typical Clinical Presentation of Cervical Radiculopathy
The hallmark features of cervical radiculopathy are confined to the cervical spine and upper extremities:
- Pain distribution: Neck pain with radiating arm pain following a dermatomal pattern, often described as "electric" in quality 1, 2
- Sensory changes: Numbness or tingling in specific dermatomes corresponding to the affected nerve root 2, 3
- Motor deficits: Weakness in muscle groups corresponding to the affected myotome (C5-C6 and C7 most commonly affected) 1, 2
- Reflex changes: Diminished deep tendon reflexes, particularly triceps reflex 3
Red Flags That Should Prompt Alternative Diagnosis
If a patient presents with syncope in the context of cervical spine pathology, consider these alternative diagnoses:
- Cervical myelopathy: When symptoms extend beyond the upper extremity to include bilateral symptoms, lower extremity involvement, gait instability, or bladder/bowel dysfunction, this indicates spinal cord compression rather than isolated nerve root compression 1, 4
- Vertebrobasilar insufficiency: Syncope with neck movement could suggest vascular compromise rather than radiculopathy
- Autonomic dysfunction: Syncope requires evaluation of cardiovascular and autonomic nervous system pathology, which is unrelated to cervical nerve root compression
Critical Diagnostic Considerations
When evaluating atypical presentations:
- Unilateral arm and leg symptoms together raise concern for cervical myelopathy with long tract signs, not simple radiculopathy 1
- Bilateral symptoms may indicate myelopathy risk requiring urgent evaluation 1
- Progressive neurological deficits, bladder/bowel changes, or loss of perineal sensation are red flags requiring urgent evaluation and suggest myelopathy rather than radiculopathy 1
Appropriate Workup for True Cervical Radiculopathy
If cervical radiculopathy is suspected (without syncope):
- MRI of the cervical spine without contrast is the imaging modality of choice, correctly predicting 88% of lesions causing nerve root impingement 5, 1
- Clinical correlation is mandatory: MRI findings must correlate with symptoms, as false positives are common in asymptomatic patients 5, 4
- Electrodiagnostic testing should be reserved for atypical symptoms or when peripheral neuropathy is a likely alternative diagnosis 4, 6
Common Pitfall to Avoid
Do not attribute syncope to cervical radiculopathy. The presence of syncope in a patient with cervical spine pathology requires a separate cardiovascular, neurological, or autonomic evaluation. Cervical radiculopathy produces upper extremity symptoms only, and any presentation extending beyond this distribution warrants consideration of alternative diagnoses such as myelopathy, multiple levels of pathology, or non-spinal neurological disorders 1, 2.