Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Worsening Back Pain And Leg Weakness


Consult Page

73M PMH diastolic heart failure, here with back pain, LE weakness, and recurrent falls

Initial Imaging

Fig. 41.1, A. Sagittal T2-weighted MRI of the thoracolumbar spine without contrast demonstrates a round, well-circumscribed, hypointense intradural mass at T11-T12 with a broad base along the dural margin (arrow). B. An axial sequence demonstrates the intradural mass within the right lateral spinal canal (arrow) causing moderate narrowing of the spinal canal with leftward displacement and compression of distal thoracic cord/conus medullaris. There is minimal contrast enhancement of the mass (not pictured here), which can be seen with dense calcification.

Walking Thoughts

  • ■

    What is the patient’s neurological exam?

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    What other symptoms is he having? Are there any red-flag symptoms or concern for cauda equina syndrome?

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    What is the timeline of his symptoms (e.g. acute, chronic, progressive)?

  • ■

    Do his symptoms correlate with the imaging findings?

  • ■

    Does the patient have a cancer history?

  • ■

    What are the patient’s medical comorbidities? Is he on any anticoagulant or antiplatelet medications?

  • ■

    Does this patient need surgery and if so, when?

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