March 2019

14 y/o Male Presents with Back Pain and Leg Weakness

History & Exam

  • A 14 year old male presents with the acute onset of severe lower back pain while sitting in school and no previous history of trauma.  This progressed over 1 hour to include weakness in both lower extremities, right worse than left, difficulty walking and an episode of urinary incontinence in the school nurse’s office.
  • Review of further history was notable for several previous episodes of lower back pain in the same location, with similar – but less severe – leg weakness.  No other medical history was reported.  Birth and family history was unremarkable.
  • A previous episode of less severe back pain and leg weakness 1 year prior had been evaluated with a MRI of the spine.
  • The current exam was notable for weakness in both legs (3/5 right, 4/5 left), loss of proprioception in the ankles and toes  (right worse than left) and subjective decreased pain sensation in both legs.  After the initial episode of urinary incontinence, there was no repeated incontinent events, and rectal tone was normal.

MRI from 1 year prior to presentation

MRI from 1 year prior to presentation

Current MRI

Current MRI

Questions

 
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