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Demo Question
A 22-year-old chef comes to the surgery. He is very worried as he has begun dropping items and burned his legs after dropping a pan of soup a few days earlier.
He also reports loss of sensation over his shoulders. Apparently, the symptoms he has have been steadily worsening over the past 12 months.
On examination there is sensory loss in a shawl distribution over his shoulders. He has weakness affecting both hands and forearms, reflexes are diminished.
Which of the following is the most likely diagnosis?
Alcoholic neuropathy
Cervical spondylosis
Motor neurone disease
Spondylolisthesis
Syringomyelia
Key Learning Point
A shawl-like distribution of sensory loss, coupled with distal lower motor neurone motor loss, fits best with a diagnosis of syringomyelia.
Explanation
CT scanning is the optimal investigation with respect to demonstrating the fluid filled cavity within the cord. A number of neurosurgical options are proposed to limit progression of the syrinx.
Cervical spondylosis is associated with neck pain and cervical radiculopathy.
Spondylolisthesis also presents with neck pain and symptoms of root compression.
Alcoholic neuropathy presents with peripheral sensory symptoms.
