26th August 2024

A 71-year-old man is referred to neurology due to difficulty doing up buttons and numbness in his fingers

A 71-year-old man is referred to neurology due to difficulty doing up buttons and numbness in his fingers. He has a background of prostate cancer, for which he is on goserelin, and CLL, for which he is not currently on treatment. He has started walking with a stick recently due to a fall a few weeks ago and has generally felt unsteady on his feet for the past few months, which he attributed to getting older. He also describes a long-term history of neck pain for which he takes naproxen regularly.

On examination, he has weakness and numbness in his hands. In his legs, you note increased tone, hyperreflexia with upgoing plantars and mild weakness throughout. Flexion of his neck seems to worsen his symptoms. What is the most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.