A 68yr old lady with a history of osteoarthritis had a history of episodic neck pain for some years. The pain fluctuated, but most of the time was manageable. It was associated with some paraesthesia in the right index finger. More recently ,she had become concerned about her walking. Her legs felt stiff and heavy .she seemed to drag them.
She also began to experience some numbness in her feet and developed urinary frequency and some urgency.
On examination, her cranial nerve were normal. She had slight restriction of neck movement .her right triceps jerk was exaggerated ,but the biceps and supinator reflexes were absent on the right and were associated with brisk finger flexion. She had decrease sensation in the right index finger. Her legs were spastic with brisk reflexes and the right plantar response was equivocal. She had minimal hip flexion weakness bilaterally. Joint position sense and vibration sense were impaired in the toes and her gait appeared slightly spastic.
1-what segmental level is suggested by the upper limb motor findings?
2-what segmental level is suggested by the upper limb sensory findings?
3-what is the significance of the signs in the leg?
4-what is the interpretation of the upper limb reflex change?
5-how should she be investigated?
6-what is the likely pathology and how would she be treated?
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