Spinal Cord - Cervical Myelopathy

 

Very varied signs

 

The salient findings on examination were bilateral weakness with upper motor neuron signs with symmetrical sensory deficit, which is suggestive of a cervical cord lesion.

 

The gait had a spastic, scissoring quality.

 

There was increased tone. (UMN vs. LMN depends on the site of lesion - if at level, it will be LMN, if below then may see increase spasticity).

 

There was symmetrical weakness (and not always symmetrical...). On extension, there was deficient adduction of the little finger, which may suggest the ‘myelopathic hand sign’.

 

Reflexes were brisk (but also may be reduced if at this level).

 

There was sensory deficit for dorsal column and pain sensation in a dermatomal distribution (may be present). If profound proprioception loss, may have ‘pseudo athetosis’ (slow writhing).

 

Differential diagnoses would include:

• Cervical myelopathy

• Other cervical cord disorders

  • Extrinsic

    • Mass or tumour

    • Epidural abscess

  • Intrinsic

    • Infarction

    • Transverse myelitis

    • Vascular malformation

    • Syringomyelia

    • Subacute combined degeneration

• ALS - although I would expect mixed LMN and UMN signs as well as no sensory deficits

 

Note, C5-C7 is most commonly affected and so may see LMN signs at these levels. This would include biceps and BR reflex, and maybe triceps (C7, C8).

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