Which finding is NOT typical of myelopathy and would prompt alternative consideration?

• A. Hyperreflexia
• B. Gait disturbance
• C. Positive Babinski
• D. Fasciculations in distal limbs

Answer: (D)

Myelopathy typically disrupts the spinal cord and produces upper motor neuron signs: hyperreflexia reflects loss of descending inhibitory control, gait disturbance arises from spasticity and poor coordination, and a positive Babinski indicates corticospinal tract dysfunction. Fasciculations in distal limbs, on the other hand, are lower motor neuron signs produced by irritation or loss of motor neurons or peripheral nerves. Their presence suggests another process—such as peripheral neuropathy, radiculopathy, or motor neuron disease—rather than isolated spinal cord myelopathy. In acute settings you can see transient LMN findings, but the classic picture of myelopathy centers on UMN signs, so distal fasciculations would prompt reconsideration of the diagnosis.