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Myelopathy vs MND — RACP Adult Medicine MCQ

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ModerateNeurologyMyelopathy vs MNDRACP Adult Medicine

A 62-year-old man presents with progressive bilateral hand weakness and wasting affecting the thenar and hypothenar eminences. He has reduced vibration sense in the feet and absent ankle jerks. MRI cervical spine shows degenerative changes with spinal cord compression at C5–C6. What clinical sign distinguishes cervical myelopathy from motor neurone disease?

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Correct answer: E — Muscle wasting

The key distinguishing feature is sensory loss – which is present in cervical myelopathy (dorsal column involvement causing reduced vibration and proprioception) but ABSENT in motor neurone disease (which is a pure motor disorder). Both can cause upper motor neurone signs in the legs (spasticity, hyperreflexia) and lower motor neurone signs in the hands (wasting, weakness). Cervical myelopathy also causes neck pain and a positive Lhermitte's sign. MRI is essential to distinguish the two conditions.

Reference: eTG – 2025 – Neurology