Case 8: A Young Man With Painful Inability to Walk

Presenter: Christopher H. Gibbons, MD, Resident, Department of Neurology, Johns Hopkins Hospital, Baltimore, MarylandPreceptor: Justin C. McArthur, MBBS, MPH, Professor of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland

October 19, 2001

In This Article

Case Presentation & History

A 22-year-old, right handed, white man presented with the inability to walk.

The patient had been in his usual state of health until the morning of admission. He awoke at approximately 8 AM and found he was unable to get out of bed. When he tried to move his legs he experienced extreme pain in his upper legs and lower back. The patient said initially the pain was severe and stabbing, but was lessened by immobility. He stayed in bed for several hours but the pain progressed through the morning to a constant horrible stabbing pain rated 10/10 even at rest.

The patient was brought to the emergency department by EMS in terrible pain and completely unable to move his legs. He admitted that if the pain were less he might be able to move his legs. However he was unable to attempt it at that time due to the excruciating pain.

When asked to describe the pain, the patient said it was localized to his upper legs, inner thighs, buttocks, and lower back. The pain did not radiate down the patient's legs. He was experiencing some associated numbness and tingling over the affected areas, however, he still had sensation in those areas.

The patient did not describe any recent trauma to those areas and no recent physical activity. When further pushed to discuss his recent routine he mentioned helping his sister move heavy furniture 2 days prior to admission, however he had felt no untoward effects since that time.

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