Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: August 16, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Differential Diagnosis for Shock-like Paresthesia with Axial Load and Neck Flexion

  • Single most likely diagnosis:
    • Cervical Spondylotic Myelopathy (CSM): This condition is characterized by compression of the spinal cord in the cervical spine, often due to degenerative changes. The symptoms can include shock-like paresthesia (often referred to as Lhermitte's sign) when the neck is flexed, which is a classic presentation for this condition.
  • Other Likely diagnoses:
    • Multiple Sclerosis (MS): MS can cause a wide range of neurological symptoms, including Lhermitte's sign. This symptom is particularly common in patients with MS, especially during the relapsing-remitting phase.
    • Cervical Disc Herniation: Herniation of a cervical disc can compress the spinal cord or nerve roots, leading to various symptoms, including paresthesia. The specific symptom of shock-like paresthesia with neck flexion could be indicative of cord compression.
    • Chiari Malformation: This condition involves the cerebellum extending into the spinal canal, which can compress the spinal cord and cause symptoms similar to those described, including Lhermitte's sign.
  • Do Not Miss diagnoses:
    • Spinal Epidural Abscess: Although rare, this condition is a medical emergency that requires prompt diagnosis and treatment. Symptoms can include severe back or neck pain, fever, and neurological deficits, which could initially present with paresthesia.
    • Spinal Cord Infarction: This is another emergency condition that could present with sudden onset of neurological symptoms, including paresthesia, due to interruption of blood supply to the spinal cord.
  • Rare diagnoses:
    • Subacute Combined Degeneration (Vitamin B12 Deficiency): This condition affects the spinal cord and can cause a variety of neurological symptoms, including paresthesia. However, it is less likely to be directly associated with axial load and neck flexion.
    • Syringomyelia: A condition characterized by the formation of a fluid-filled cavity within the spinal cord, which can expand and cause damage to the surrounding nerve tissue, leading to symptoms like paresthesia. The presentation can be varied and might include symptoms exacerbated by certain positions or movements.

Related Questions

How to manage mucositis in a patient taking Inquovi (decitabine and cedazuridine)?
What is C-peptide (Connecting peptide) lab used for?
What is the appropriate treatment for enterococcal empyema?
What is the initial workup and management for a young patient presenting with hemoptysis, diffuse patchy nodular opacities on computed tomography (CT) scan, and moderate pericardial effusion, including potential rheumatologic (rheum) conditions?
When should Paxlovid (nirmatrelvir/ritonavir) be started in patients with COVID-19?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question