Case 9: A Woman with Spasms and Stiff Legs

Presenter: , Chief Resident, Neurology, Johns Hopkins Medical Institutions, Baltimore, MarylandMentor: , Clinical and Research Fellow of Neurology, Johns Hopkins Medical Institutions, Baltimore, Maryland

December 05, 2001

In This Article

Case Presentation

A 60-year-old right-handed woman presented with painful spasms and stiffness of the legs, which was worse on the right than the left.

Four months before admission to Johns Hopkins Hospital, the patient began to experience insidiously worsening burning and tingling in both feet. These paresthesias became more bothersome and ascended to involve her entire right leg. She consulted her primary care physician, simultaneously noting a nontender swelling of the left axilla that did not resolve after a course of oral antibiotics. A mammogram was negative. About 2 to 3 weeks later she began to experience painful flexor spasms of the right foot.

One month before admission the patient experienced an acute exacerbation of symptoms such that both legs were involved, with spasms and tingling. An outside psychiatrist felt the patient was "anxious" but otherwise normal. At that time, consultation at another hospital documented that she had normal strength and sensation; "spasticity of the legs with inversion of her feet and curling of her toes;" "reflexes 2+ and up-going toes bilaterally"; and spontaneous painful spasms of her legs. She was also "at times intolerant of light touch." She received trials of several different medications including cyclobenzaprine, lorazepam, diazepam, and alprazolam; baclofen provided the most substantial relief. However, she remained wheelchair-bound despite 3 weeks of physical therapy and subsequent admission to a rehabilitation center.

On admission to our hospital, she complained of extreme stiffness in both legs and painful, spontaneous leg spasms that became worse with movement or with stimulation.

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