A 58-year-old man comes to the physician because of burning pain in his neck and arms for a year. He has also had paresthesias in his hands during this period. He has had increasing weakness in both hands during the past 3 months. He has type 2 diabetes mellitus, hypercholesterolemia, and hypertension. He was involved in a motor vehicle collision 3 years ago. Current medications include metformin, sitagliptin, enalapril, atorvastatin, and aspirin. Examination of the upper extremities shows decreased muscle strength, absent reflexes, and decreased hand grip with fasciculations bilaterally. Sensation to temperature and pain is absent over the chest and bilateral upper arms. Vibration and joint position sensations are present in the upper limbs. Cranial nerve examination shows no focal findings. Which of the following is the most likely cause of this patient's problems?

Question

Quizplus · Accepted Answer

Eductional Objective: The combination of fixed segmental loss of upper extremity pain and temperature sensations, upper extremity lower motor neuron signs, and/or lower extremity upper motor neuron signs in the setting of scoliosis suggests syringomyelia.

A 58-Year-Old Man Comes to the Physician Because of Burning