A 27 year old previously well man developed mid-back pain immediately after doing “star jumps”. The pain was not relieved by rest and was associated with increasing weakness and sensory disturbance of the legs. On admission to hospital 72 hours later he had asymmetric flaccid weakness of the legs, absent deep tendon reflexes, flexor plantar responses, and reduced sensation to T4 on the left and T8 on the right. Perineal sensation was preserved but he required the insertion of a urinary catheter because of urinary retention. Examination was otherwise unremarkable.

Questions

(1)  What is the investigation and what does it show (fig 1)?

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

(2) What should be done next?

(3) Are any other investigations indicated?

(4)  What long term problems might this young man complain of and how should they be managed?

Answers on p 314 .