]> 2026-07-31T07:52:13+00:00 WBR0575 0 en This image depicts multiple, non-patterned white matter lesions usually observed in patients with multiple sclerosis. This image depicts an expanding central canal that compresses adjacent tracts typically observed in syringomyelia. Spinothalamic tracts are often affected first in syringomyelia due to the anatomic proximity of the anterior white commissure that carries these tracts. Isolated dorsal column lesions are classical of tabes dorsalis caused by tertiary syphilis. Pathophysiology A 36-year-old woman presents to the neurology clinic with a complaint of a 1 week history of bilateral upper extremity weakness. Upon further questioning, the patient reports that for the past 3 months, she has had multiple burns in both hands because she cannot seem to distinguish hot objects. She also reports she has numbness over the shoulders and the arms that follow a cape-like pattern. Physical examination is remarkable for burn marks in both hands, loss of pain and temperature sensation in the shoulders and arms, and diminished upper extremity reflexes bilaterally. Which of the following images depicts the most likely location of the patient's lesion (lesion in red)? D Neurology 2020-10-28T01:00:27Z 2459150.5419792 WBR0575