ABSTRACT
Examination Cardiorespiratory and abdominal examinations are unremarkable. There is no rash or lymphadenopathy. Cranial nerve examination is normal, and no spinal tenderness is elicited. In the upper limb, tone is normal. His hands appear to have slight wasting bilaterally, with mild weakness, but other myotomes are within normal limits. There is no wrist tenderness. Reflexes in the arms are absent. Light touch sensation is intact throughout the upper limbs, but pain sensation is absent bilaterally from C4 to T4 distribution. In the lower limbs, the tone is elevated with ankle clonus bilaterally. Power is globally reduced to 4/5 (Medical Research Council scale), and there is hyper-reflexia. All sensation modalities are intact in the lower limbs. Coordination and vibration sense are preserved in all limbs. Anal tone and perineal sensation are intact. A chest X-ray shows no abnormalities. Observations: temperature 36.5°C, heart rate 80/min, blood pressure 105/70 mmHg, SaO2 100 per cent on room air.
