A 67-year-old man was admitted after a fall at home.
He intended to sit down, but the chair was not where he thought it was, and he fell on his buttocks in the sitting position. He was brought to the emergency department complaining of inability to walk and difficulty voiding.
Medical history included obesity, diabetes, hypertension, myocardial infarction and coronary stenting, and right brachial plexus injury at birth.
Vital signs, electrocardiogram, and X-rays were normal, as was the general physical examination. Neurological examination revealed severe flaccid paraparesis (later 0/5) with diminished reflexes and negative Babinski sign. Left-hand weakness was also observed (3/5). Cranial nerves were normal. Urinary retention was found on bladder catheterization (900 mL).
Laboratory tests were normal except serum creatinine 1.5 mg/dL (recently: 1.0 mg/dL).
Head and thoracolumbar computed tomography were unremarkable. Magnetic resonance imaging demonstrated cervical spinal stenosis with “string-like” cord and degenerative vertebral changes (Figure 1, Figure 2). He was urgently operated on (C3-C6 laminectomy and cervical fusion) but unfortunately failed to show any significant improvement.
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-Ami Schattner, MDa,c, Yair Glick, MDb, Ina Dubin, MDa
This article originally appeared in the June 2019 issue of The American Journal of Medicine.
