11-20-2011, 07:34 PM
18. A 39-year-old African-American woman is brought to the health center at 7:00 PM by her children because of weakness and numbness in her right leg. She also says, "I have an odd feeling in my left leg." The symptoms started several days ago and gradually have increased. She also experienced low back pain about 10 days ago, which responded until recently to oral morphine and ibuprofen prescribed by her primary care physician, whom she could not reach tonight. She has had no problems with bowel or bladder function. She was treated 4 months ago with mastectomy, chemotherapy and radiation therapy for infiltrating ductal carcinoma of the left breast. Neurologic examination today discloses weakness of all muscle groups in the right leg and thigh, with normal strength in the left leg. There is marked decrease in sensation to pinprick and temperature up to the area of the inguinal ligament on the right, and decreased perception of position and vibration sense in the left lower extremity. The patellar and Achilles reflexes are hyperactive on the right and those on the left are normal. Rectal sphincter tone is normal. Diagnostic studies show metastatic disease to L2 with minimum invasion of the spinal canal. Which of the following is the most appropriate method to control her pain?
A) Chemotherapy
B) Dorsal rhizotomy
C) Long-acting oral morphine therapy
D) Radiation therapy
E) Surgical decompression