07-18-2009, 11:06 PM
A 64-year-old woman is evaluated in the emergency department for a 4-day history of progressive leg weakness and numbness and a 1-day history of urinary incontinence. She has also had increasingly severe midback pain for the past 2 months. She has a history of breast cancer diagnosed 2 years ago, treated with surgery and local radiation therapy. Her only current medication is tamoxifen.
Physical examination shows normal mental status and cranial nerves. Strength in the arms is normal. Legs are diffusely weak, 3/5 proximally and 4/5 distally. Sensory examination shows diminished pin sensation from the nipples downward; vibratory sense is severely diminished in the feet. Reflexes are 2+ in the biceps and triceps and 3+ in the knees and ankles. An extensor plantar response is present bilaterally. Anal sphincter tone is diminished.
Which of the following is the most appropriate diagnostic study at this time?
A CT of the lumbar spine
B Electromyography and nerve conduction studies
C MRI of the brain
D MRI of the entire spine
E Plain radiographs of the entire spine
Physical examination shows normal mental status and cranial nerves. Strength in the arms is normal. Legs are diffusely weak, 3/5 proximally and 4/5 distally. Sensory examination shows diminished pin sensation from the nipples downward; vibratory sense is severely diminished in the feet. Reflexes are 2+ in the biceps and triceps and 3+ in the knees and ankles. An extensor plantar response is present bilaterally. Anal sphincter tone is diminished.
Which of the following is the most appropriate diagnostic study at this time?
A CT of the lumbar spine
B Electromyography and nerve conduction studies
C MRI of the brain
D MRI of the entire spine
E Plain radiographs of the entire spine