Neurology: syringomyelia: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Neurology: syringomyelia

Sample item

A 30-year-old man has painless burns on both hands, wasting of the small hand muscles, and loss of pain and temperature over both shoulders and arms in a cape distribution, with preserved touch and vibration. Arm reflexes are absent and his legs are spastic. Which investigation is most useful?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. MRI of the brain and whole spine including the craniocervical junction

Syringomyelia is a fluid-filled cavity in the central cervical cord that interrupts crossing spinothalamic fibres, causing a suspended dissociated sensory loss with preserved dorsal column function. Anterior horn involvement causes hand wasting, and later pyramidal signs appear. Many cases are associated with Chiari I malformation, so MRI of the brain and craniocervical junction is needed.

Option by option

  • A. CSF analysis for oligoclonal bands

    Oligoclonal bands suggest multiple sclerosis, which is not the cause of a central cavity.

  • B. Nerve conduction studies of the median nerve

    Nerve conduction studies assess peripheral nerve entrapment and would not explain a cape-like sensory loss with spastic legs.

  • C. Plain radiograph of the lumbar spine

    A lumbar radiograph does not image the cervical cord and cannot show a syrinx.

  • D. MRI of the brain and whole spine including the craniocervical junction (correct)

    MRI shows the syrinx and any Chiari malformation or tumour, and guides surgical decompression.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, MRI of the brain and whole spine including the craniocervical junction. Syringomyelia is a fluid-filled cavity in the central cervical cord that interrupts crossing spinothalamic fibres, causing a suspended dissociated sensory loss with preserved dorsal column function.

Why is "CSF analysis for oligoclonal bands" not the answer?

Oligoclonal bands suggest multiple sclerosis, which is not the cause of a central cavity.

Why is "Nerve conduction studies of the median nerve" not the answer?

Nerve conduction studies assess peripheral nerve entrapment and would not explain a cape-like sensory loss with spastic legs.

Why is "Plain radiograph of the lumbar spine" not the answer?

A lumbar radiograph does not image the cervical cord and cannot show a syrinx.

What concept does this question test?

It tests Neurology: syringomyelia in General Medicine. Anterior horn involvement causes hand wasting, and later pyramidal signs appear. Many cases are associated with Chiari I malformation, so MRI of the brain and craniocervical junction is needed.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: syringomyelia?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.