[JNUS]

CLINICAL BACKGROUND

An 87-year-old woman presents to the emergency department (ED) with acute onset of inability to move both of her legs over the past day. She had been hospitalized and discharged 2 weeks ago for a pulmonary embolism and at the time of discharge was feeling well and mobilizing independently. The patient reports mild progressive weakness of her lower limbs over the past 6 months with accompanying back pain. She states that she was able to walk and do her normal activities during that time without difficulty. She has a history of osteoporosis and had a radical nephrectomy for renal cell carcinoma 7 years ago.

On physical examination, the patient appears well, though slightly cachectic. She has a pulse of 90 bpm, a blood pressure of 130/90 mm Hg, and a temperature of 97.7°F (36.5°C). The cardiac and pulmonary examinations are unremarkable, with a regular rhythm and no increased work of breathing. She has a soft abdomen with no rebound or tenderness to palpation. There is evidence of a well-healed scar from her previous nephrectomy. On a scale from 1 to 5, with 5 being full strength, she describes her strength as a 0 in the right leg and a 2 in the left leg. Pain and temperature sensation is absent throughout the lower limbs. There is slightly decreased rectal tone. The remainder of her physical examination is unremarkable.

A magnetic resonance imaging (MRI) scan of the thoraco-lumbar spine is performed (see Images 1 and 2).

What is the diagnosis?

HINT
The recurrence of a prior medical condition is likely responsible