Signs

Atrophy of intrinsic hand muscles

Babinski sign

Clonus: Achilles tendon is more commonly affected than the patella

Gait disturbance: wide-based ataxic gait

Hyperreflexia of the deep tendon reflexes

Hyporeflexia of superficial reflexes (abdominal and cremasteric)

Lhermitte sign (27%)

Pathologic (upper motor neuron) reflexes: Hoffmann sign inverted brachioradialis reflex, Romberg sign, and Brissaud reflex

Pyramidal weakness: upper extremity extensors > upper and lower extremity flexors > lower extremity extensors

Spasticity

Synkinesis: involuntary movement in a limb associated with voluntary movement of other limbs

Symptoms

Ascending paresthesia in the upper and lower extremities

Autonomic: erectile dysfunction, difficulty with elimination (44%), or bowel or bladder incontinence

Decreased hand dexterity, changes in handwriting

Falls

Lower extremity stiffness, weakness, and sensory loss

Neck pain (50%) and stiffness

Radicular pain (38%)

Scapular pain