skip to main content

Degenerative cervical myelopathy presenting as falls — SCE Geriatric Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardNeurologyDegenerative cervical myelopathy presenting as fallsSCE Geriatric Medicine

An 82-year-old man has progressive gait slowing and falls. Examination shows lower-limb spasticity, brisk reflexes, extensor plantar responses and impaired vibration sense; hand dexterity has deteriorated. MRI brain shows small-vessel disease, but cervical spine MRI shows cord compression at C4/5 with T2 signal change. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Degenerative cervical myelopathy

Upper motor neurone signs, hand dysfunction and MRI cord compression with signal change indicate degenerative cervical myelopathy. Small-vessel disease may be incidental and should not distract from spinal cord signs. Parkinson disease causes bradykinesia and rigidity rather than pyramidal signs. The pearl is to examine reflexes and plantar responses in older adults with unexplained falls.

Reference: NICE CKS Cervical myelopathy; JRCPTB geriatric curriculum