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Answers on p 359.
A 45 year old man presented to the neurology clinic with a history of numbness for the previous two months followed by weakness for one month of all four limbs. The weakness involved the left upper limb followed by left lower limb, right lower limb, and right upper limb in that order. There was also a history of hesitancy in voiding urine. There was no history of trauma, fever, seizures, abnormal involuntary movement, or symptoms of increased intracranial tension. Examination revealed no abnormality of the cardiovascular, respiratory, or gastroenterological systems. Neurological examination showed normal higher function and no abnormality of cranial nerves. Motor system examination revealed atrophy of small muscles of the hand in the left upper limb, tone was increased in all four limbs, while power was more decreased in the lower limbs (grade III) when compared with the upper limbs (grade IV). Sensory system examination revealed a decrease in sensations with upper level at the C4 dermatome (posterior column was more affected than the spinothalamic). On examination of the reflexes, the biceps was absent while the supinator/triceps was increased in the left upper limb as were reflexes in the other three limbs. Abdominal reflex was absent whereas the plantar was bilaterally extensor. Computed tomography of the head revealed normal findings. Magnetic resonance imaging (MRI) of the spine (fig 1) showed a low intensity lesion at C5–6 with a slightly hyperintense nodule on T1W1 and high intensity lesion on T2W1 with widened cord. Laminectomy was performed and the lesion removed was sent for histopathology (fig 2).
What is the diagnosis?
What are the treatment options?