We would like to graciously acknowledge Karen Smith, MD FRCPC for her contribution to the development of this case study.
Mrs. FL is a 42-year-old female previously employed for 16 years as the secretary for a large accounting firm. She immigrated to Canada from Northern Ireland 20 years ago. On Christmas day of last year she developed a burning pain in her feet, which over the course of that day evolved into bilateral paresthesias. Over the next several days she had progressive ascending sensory loss, which involved the entire body below the armpits, as well as the medial arms, small, ring, and long fingers. On New Year’s Day she was admitted to hospital for management of urinary retention of 18 hours duration and constipation of 10 days duration. Her condition stabilized. She was seen in consultation by the neurology department and underwent an MRI of the head and spine, lumbar puncture, and screening bloodwork. Multiple plaques were identified, suggesting transverse myelitis with no known trigger as the cause of her symptoms. She is a C6 AIS B patient.
She was transferred to an inpatient acute spinal cord injury rehabilitation unit on January 4th, and she remained an inpatient for 6 weeks. See Figure 1 and 2 for Mrs. FL’s health status.
Figure 1. Mrs. FL's presenting condition.
Figure 2. C6 AIS B, spinal injury. From Medical Illustration (c) 2010 Nucleus Medical Media, Inc.