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MBBS QUESTION #10277
Question 1
A patient with syringomyelia presents with loss of pain and temperature sensation in a 'cape-like' distribution over the shoulders and upper limbs, while vibration and proprioception (dorsal column function) remain intact. This selective loss is best explained by damage to:
  • The decussating fibers of the lateral spinothalamic tract as they cross in the anterior white commissure near the syrinx✔️
  • Both dorsal columns bilaterally, sparing all other tracts
  • Both corticospinal tracts bilaterally
  • The dorsal root ganglia bilaterally, sparing the spinal cord itself
Correct Answer Explanation
A syrinx (fluid-filled cavity) typically expands in the central spinal cord, first damaging the decussating spinothalamic fibers crossing in the anterior white commissure at that level, causing a segmental, bilateral loss of pain/temperature sensation while sparing the more peripherally located dorsal columns — the classic 'cape-like' or 'suspended' sensory loss.