| Patient 1 | Patient 2 (Fig. 1) |
---|---|---|
Gender | Female | Male |
Age (years) | 59 | 37 |
Level | th8 | th7 |
Previous history | Hypertension | Car accident 10 years prior without severe injuries |
Medical history | Pregabalin, Valsartan | Amitriptyline, Omeprazole |
Family history | Uneventful | Uneventful |
Psychosocial history | Recreational alcoholic consumption, non-smoker, housewife, married | Recreational alcoholic consumption, smoker, unemployed, married |
Duration of symptoms | 1 year | 10 years, soon after the accident |
Course until presentation | Progressive | Somewhat gradually |
Clinical symptoms | Loss of sensitivity to touch, pain, and temperature in the left leg, buttock, and side of the torso below the ribcage; less strength in the left leg | Dull pain initially only on the left side and discrete loss of sensitivity in a 6-in. band around the ribcage; later, sensitivity was also altered in the left leg; strength remained normal |
Physical exam | Vital and gnostic sensibility loss distal to th10 on the left side, discrete paresis of the left biceps femoris muscle (MRC grade 4/5), and symmetrical hyporeflexia in the arms and legs, except for a positive Babinski’s sign on both sides | Sensibility loss distal to th12 on the left side; motor strength and reflexes were normal |
Treatment | Surgical exploration and untethering of the spinal cord | Refused surgery |
Course | Two years postoperatively: no progression of clinical signs and symptoms after an uneventful postoperative course | Remained very afraid of surgery three years after his first presentation although the clinical signs and symptoms slowly but gradually had worsened |