A 5-year-old, male neutered Yorkshire Terrier was referred to the Cornell University Emergency Service for progressive cervical pain and ataxia. On presentation, the patient had normal vital signs and demonstrated a non-ambulatory tetraparesis with delayed postural reactions in the thoracic limbs, no neurologic deficits in the hind limbs, and cervical pain. An atypical presentation of a C1-C5 myelopathy, “central cord syndrome” was suspected, characterized by dysfunction in the thoracic limbs with minimal deficits in the pelvic limbs. The diagnostic workup included routine bloodwork, magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analysis. The MRI revealed a severe, locally extensive, meningomyelopathy from C1-C6 with moderate mass effect from C2-C5. Prioritized differential diagnoses included meningomyelitis of unknown etiology (MUE) or neoplasia. The patient started immunomodulatory therapy and four weeks later was strongly ambulatory with a mild generalized proprioceptive ataxia. This report will discuss central cord syndrome, and the diagnostic findings, treatment, and prognosis for MUE.