The absence of upper limb symptoms argues against a diffuse process, such as polyneuropathy. Physical examination must include assessment of the lower sacral segments. The patient's nocturnal pain raises the suspicion of malignancy. The patient is an alert, oriented and slightly overweight man. The examination is performed with the patient in bed.
Cranial nerves appear intact.
No weakness is detected in the upper limbs and there is no Bevor sign. Anal tone is reduced, but the patient can voluntarily control the anal sphincter. Muscle stretch reflexes in the upper limbs are present and symmetric bilaterally. Knee and ankle reflexes are absent. Hoffman and Babinski signs are not present.