Intended for healthcare professionals

Endgames Case Review

A 51 year old woman with leg weakness after falling

BMJ 2019; 364 doi: (Published 03 January 2019) Cite this as: BMJ 2019;364:k4773
  1. Shlok Gupta, staff internist,, assistant clinical professor (adjunct)12
  1. 1Niagara Health System, St Catharines, ON, Canada
  2. 2McMaster University (Niagara Regional Campus), St Catharines, ON, Canada
  1. Correspondence to S Gupta shlok.gupta{at}

A 51 year old woman presented to the emergency department after being found on the floor beside her bed—she had fallen and was unable to get up. She had no angina, palpitations, dyspnoea, nausea, diaphoresis, or loss of consciousness before, during, or after the fall. She reported difficulty passing urine for 4-6 weeks. Her history included hypercholestrolaemia, generalised anxiety disorder, and gastroesophageal reflux.

She had facial bruising and was unable to walk. Cardiopulmonary examinations were normal. Table 1 shows her strength examination results. Reflexes were 3+at the biceps, triceps, brachioradialis, patella, and Achilles tendons. Ankle plantar responses were upgoing bilaterally (Babinski sign) with spasticity in the legs and sustained clonus at the ankle. Hoffman sign was negative. Digital rectal examination revealed normal tone. Proprioception testing at the big toe was normal. Sensory examination was normal to light touch. Magnetic resonance imaging (MRI) was performed (fig 1).

Fig 1

T2 weighted MRI of the spine

View this table:
Table 1

Strength examination results according to …

View Full Text

Log in

Log in through your institution


* For online subscription