26th August 2024

A 72-year-old man returns to your clinic. He originally presented with pain and weakness

A 72-year-old man returns to your clinic. He originally presented with pain and weakness in his right arm. An MRI showed a compressive radiculopathy of his C6 nerve root, and you referred him for neurosurgical input. He has now returned to your clinic for review 10 weeks after the cervical spine decompression surgery. The weakness in his arm has improved, and as has the pain. However, his wife has noted that his voice sounds weaker than previously and is breathy and hoarse. He has also noted that he tends to cough when he drinks water or other fluids recently. You perform a full examination and can find no signs of upper respiratory tract infection, can palpate no masses in the anterior neck, and his chest is clear. Which of the following is it most important to rule out as a cause for this man’s symptoms?

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