Intended for healthcare professionals

Endgames Case Review

A 51 year old woman with leg weakness after falling

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k4773 (Published 03 January 2019) Cite this as: BMJ 2019;364:k4773

Re: A 51 year old woman with leg weakness after falling

A 51 year old woman with leg weakness after falling - rapid response

Gupta is right to point out that cervical myelopathy can be easily missed [1], particularly if there is a history of low back pain.
All patients presenting with spinal symptoms should have a clinical examination of the whole spine, with imaging as appropriate [2]. Spinal canal diameter which is narrow in one part of the spine may be narrow throughout the spine.

In this case, it would have been interesting to know the ethnic background of the patient as there are suggestions that the spinal canal diameter can be narrower in some ethnic groups [3].

Reference List

(1) Gupta S. A 51 year old woman with leg weakness after falling. BMJ (Clinical research ed ) 2019; 364:k4773.
(2) Crocker M. A 51 year old woman with leg weakness after falling - rapid response. BMJ rapid responses 2019;(4th January 2019):k4773/rapid responses.
(3) Bentley P, Grigor C, McNally J, Rigby S, Higgens C, Frank AO et al. Degenerate cervical disc disease presenting as cord compression in young adults. BMJ 2001; 322(17 February):414-415.

Competing interests: No competing interests

05 January 2019
Andrew O. Frank
Retired consultant physician in rehabilitation medicine and rheumatology
Arthritis Centre
Northwick Park Hosptial, harrow, HA1 3UJ