Iain John McGurgan

The tuning-fork is firmly established in the neurologist’s diagnostic armamentarium, having taken its pride of place for the investigation of hearing long before that of vibration sense. And is it any surprise? Sleek burnished steel, brandished by the neurologist at the faintest mention of hearing loss, is struck exuberantly against the elbow with a satisfying ping, echoing the confidence of the examiner that the ensuing tests will definitively distinguish a conductive from a sensorineural loss.

The tuning-fork is firmly established in the neurologist’s diagnostic armamentarium, having taken its pride of place for the investigation of hearing long before that of vibration sense. And is it any surprise? Sleek burnished steel, brandished by the neurologist at the faintest mention of hearing loss, is struck exuberantly against the elbow with a satisfying ping, echoing the confidence of the examiner that the ensuing tests will definitively distinguish a conductive from a sensorineural loss.

Reported is a case of a man aged 55 years who presented with progressive spastic paraparesis. Examination demonstrated multiple cutaneous telangiectases. Subsequent development of upper limb weakness, acute urinary retention and eventual respiratory compromise resulted in the requirement for intensive care unit admission and mechanical ventilation. MRI spine revealed diffuse T2 hyperintensity in the cervical cord with enhancement and cord expansion.