A 45-year-old man presents with a 6-month history of bilateral hand numbness, clumsiness with fine motor tasks, and a sensation of electric shock radiating down the spine on neck flexion. MRI reveals a cystic cavity within the cervical spinal cord from C3 to C6. What is the most likely diagnosis?

• A Cervical spondylotic myelopathy
• B Multiple sclerosis
• C Intramedullary tumor
• D Syringomyelia ✓

Explanation

Syringomyelia is characterized by a fluid-filled cavity (syrinx) within the spinal cord. The classic presentation includes cape-like loss of pain and temperature (dissociated sensory loss) due to crossing spinothalamic fibers at the central canal, hand numbness and weakness, and Lhermitte's sign (electric shock sensation on neck flexion). Cervical spondylotic myelopathy shows cord compression on MRI without an intrinsic cavity. Intramedullary tumor may mimic it but typically shows enhancement.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.