Examination
On general exam, patient noted to have a thyroid nodule and hirsutism.
She was well oriented with intact cranial nerves and normal upper limb
function. She however had features of thoracic myelopathy with increased
lower limb reflexes, clonus, hypertonia, Babinski sign and paraparesis
(worse on right side). There was a T4 sensory level and diminished anal
sphincter tone and peri-anal sensation. No obvious tenderness or steps
on her back and nor features of sepsis or inflammation.