Mother just came back from a visit with the neurologist. We've been concerned about her for quite some time. The results of the testing suggest some kind of pressure on her spinal cord in the neck area. Just how do they diagnose a problem like this?
The physician begins with a detailed patient history (personal and family) followed by a careful physical exam. Neurologic exams include some special tests of nerve and nervous system function. The exam can include deep tendon reflex testing, muscle testing, and sensory testing (touch, temperature, vibration).
Other special tests performed include the Hoffmann test and Babinski. The Hoffmann sign is done by quickly snapping or flicking the patient's middle fingernail. The test is positive for spinal cord compression when the tip of the index finger, ring finger, and/or thumb suddenly flex in response.
A positive Babinski sign is seen as downward flexion of the big toe and fanning outward of the toes when quick pressure is applied to the bottom of the foot from the heel to the toes.
Any time these tests are positive (and especially on both sides), further testing is warranted. The physician may order an MRI study of the spine. This shows areas of spinal cord compression and any deformity or malformation of the spinal cord.
There is also a test of function that correlates with the severity of cervical myelopathy. It's called the modified Japanese Orthopaedic Association (mJOA) scale score. Points are given for ability to eat, walk, and bathroom without difficulty. A low score indicates motor or sensory dysfunction.
John K. Houten, MD, and Louis A. Noce, MD Clinical Correlations of Cervical Myelopathy and the Hoffman Sign. In Journal of Neurosurgery: Spine. September 2008. Vol. 9. No. 3. Pp. 237-242.
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