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 Best of Five 181

 

   

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BOF: 181

A middle-aged male has slowly progressive weakness of his upper limbs. On examination of the patient the physical signs are kyphoscoliosis, wasting and weakness of the small muscles of the hand, flattening of the muscles of the ulnar border of the forearm. No reflexes can be elicited in the upper limb. Pain and temperature sensation are lost over the upper limbs and upper chest whereas light touch and proprioception remain intact. Lower limb reflexes are exaggerated and plantars are up going.

In this patient the associated feature could be:

a)      Arnold-Chiari malformation

b)      Rheumatoid arthritis

c)      Cervical spondylosis

d)      Vitamin B12 deficiency

e)      Dumbbell meningioma

 

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