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A male in his early 40’s presented to our hospital with 4 months of progressive neck pain and deformity. Patient came for medical evaluation as he had noticed increasing difficulty with his balance and an inability to maintain a horizontal gaze. He denied any falls or trauma and additionally denied subjective weakness in his extremities. He did admit that he was experiencing paresthesia like symptoms to the index fingers bilaterally.

The patient’s past medical history was significant for post-traumatic stress disorder, opioid use disorder, and IV drug use. He stated that he is actively using fentanyl and xylazine. Additional history is relevant for an admission 5 months prior for abdominal pain. He was found to have acute appendicitis as well as MSSA bacteremia. He underwent laparoscopic appendectomy however he left against medical advice on postoperative day 1 prior to completing a prolonged course of antibiotics.