The patient attended the neurosurgeon who did not find hyperreflexia but noted weakness in the thenar and opponens pollicus muscles (B) at the first appointment.

Over the next four weeks, the patient returned to the neurosurgeon four times on a weekly basis. Each week he ordered a different study.   She received flexion/extension x-rays, then a CT scan, and finally a nerve conduction study.  

CT Scan C7T1

Her flexion extension x-ray showed a 2 mm anterior slip at C7/T1 which he felt was not severe enough to warrant surgery.   NCV testing concluded a right radiculopathy and left peripheral neuropathy.  The surgeon concluded that it was a right C6/7 radiculopathy and a left ulnar peripheral neuropathy.

During this four-week period, the patient was noting increased frequency of urination, choking with eating, choking with lying on her left side at night to the point she had to wake and sit on the side of the bed.  When this happened, she experienced a quadrilateral burning sensation which she related to the surgeon.   She was also noticing mild wasting of the thenar muscles, opponens pollicus and the intrinsic muscles of both hands, left worse than right. She was having issues with strength functions of both hands.  She was not experiencing stumbling or gait changes.

Question:  Do you think the symptoms of choking are of any importance or do you think the patient overstating or embellishing the symptoms?