USMLE Forum Archives - USMLE Step 3 - Neurology - Progressive leg weakness
Neurology - Progressive leg weakness
harry206 - 02-15-10 15:16
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?
harry206 - 02-15-10 15:16
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?
The correct answer and explanation will be available after you answer.
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#1
Re: Neurology - Progressive leg weakness conym5 - 02-15-10 21:31 My answer is: d.
progressive leg weakness and numbness and history of urinary incontinence suggests spinal stenosis..MRI of the entire spine will give the diagnosis.. if no neuro abnormalities , we can do Plainr radiograph..
#3
Re: Neurology - Progressive leg weakness drsmichaels - 02-16-10 17:08 My answer is: d.
Previous Hx Cancer
Symptoms consistent with space occupying lesion
Plain films are cheap but may miss spinal cord tumor/lesion and or syrinx probably MRI spine but Id start with the T-spine
#12
Re: Neurology - Progressive leg weakness babbu5508 - 09-30-10 15:49 My answer is: d.
She has a history of breast cancer diagnosed 2 years ago and now weakness of nipple downward...rule out metastasis.
#21
Re: Neurology - Progressive leg weakness sudha2015 - 03-31-11 01:01 My answer is: d.
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
#22
Re: Neurology - Progressive leg weakness babbu5508 - 03-31-11 11:56 Breast cancer primarily metastasizes to the bone, lungs, regional lymph nodes, liver and to the brain, with the most common site being the bone.
#26
Re: Neurology - Progressive leg weakness mockingbird - 06-30-11 01:10 My answer is: d.
This is metastetis to vertebra from breast cancer.
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