Wk 9, Case 2 - Practice

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30 year old female with no significant PMH who presents with first symptom of constipation. She then developed intermittent whole leg numbness, first the left leg, then the right leg. Her sensation would return after shaking her legs multiple times. She then developed back pain and leg pain that is described as pressure, as if someone is grabbing her legs and holding them in a vice. At present, she has severe crushing pain in her hips. She was started on gabapentin that has not helped. Nothing makes the pain better. Sitting and moving makes the pain worse. She has decreased sensation in her legs, and her legs feel heavy to the point where she has had multiple falls a day. About 1 month ago, she began having to use a walker to assist her. She also endorses difficulty with initiation of urination and she does not feel that she is emptying fully. For the last 2 weeks, she has noticed intermittent decreased sexual feeling.

What is the most likely diagnosis?

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Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 9, Case 2 - Practice