Case 7: Chief Complaint: Paraplegia and Encephalopathy

Benjamin Greenberg, MD

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In This Article

Case Presentation

A 66-year-old man presented to his primary care physician with left leg pain in a sciatic nerve distribution. His initial exam reportedly identified left lower extremity weakness, which prompted a magnetic resonance image (MRI) of the lumbosacral spine. This test was interpreted as normal, but during the next 2 months, the patient's symptoms progressed to bilateral lower extremity weakness, parasthesias, and urinary and fecal incontinence. This development led to an evaluation by a neurosurgeon, who noted spasticity and hyperreflexia. Sensory testing demonstrated a possible sensory thoracic level. An MRI of the cervical, thoracic, and lumbar spine revealed a small area of an abnormal T2 hyperintense signal within the spinal cord at the ninth thoracic vertebra.

Past medical history: lumbar spine trauma at age 18; hearing loss caused by an old middle ear infection; 20-lb weight loss in the last 6 months

Social history: social ETOH, no tobacco, retired factory worker, married, 2 children; avid deer hunter who skins his own kills

Family history: father suffered a stroke, mother had diabetes

Work-up: at outside hospital

Given this information, what is the most likely diagnosis?

  1. Transverse myelitis

  2. Multiple sclerosis

  3. Devic's syndrome

  4. Vascular malformation

View the correct answer.

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