Pediatrics & Child health

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Educational objective: Acute spinal cord compression can present with loss of motor and sensory function, loss of rectal tone, and urinary retention. Management includes emergency surgical consultation, neuroimaging, and possibly intravenous glucocorticoids.

Which of the following is the best next step in management of this patient?

64-year-old man is brought to the emergency department due to sudden onset of painless lower extremity weakness. He was swimming in a pool when he suddenly felt his legs become weak and had to struggle to exit the pool. The patient has had no loss of consciousness or visual or speech problems, but he is unable to pass urine. He also has had back pain for the last 2 months. Medical history is significant for type 2 diabetes mellitus, hypertension, and osteoarthritis. Physical examination shows significant motor weakness in both legs and numbness from the umbilicus to the soles of the feet He has no sensation in the perinea! area. Rectal tone is absent A urinary catheter is placed, and 800 ml of urine is collected.

Educational objective: Spinal epidural abscess, a bacterial infection of the epidural space, typically arises in the setting of bacteremia from intravenous drug use or distant infection. Manifestations include fever, malaise, focal back pain, and progressive neurologic findings (eg, sensory, motor, reflex deficits).

Which of the fotlowinq is the most likely cause of this patient's weakness?

A 29-year-old man comes to the emergency department due to lower extremity weakness. The patient has not been feeling well over the past several days and has had worsening back pain. When he woke up this morning, he noticed weakness in both legs and had to have a friend help him walk to the car. The patient has a history of HIV, which was acquired via shared needles, but does not take antiretroviral therapy consistently. The patient still uses injection drugs occasionally but no longer shares needles. Temperature is 38 C (100.4 F), blood pressure is 116168 mm Hg, and pulse is 98/min. The lungs are clear on auscultation, and heart sounds are normal with no murmurs. Abdominal examination shows a distended bladder. The back is tender to palpation over the lower thoracic region. Neurological examination reveals 315 bilateral lower extremity muscle strength with upgoing bilateral plantar reflexes. Skin examination shows scattered folliculitis and no lower extremity edema.

Educational objective: Neoplastic epidural spinal cord compression presents with worsening focal back pain, bilateral lower-extremity weakness, sensory loss, and gait ataxia. Bowel/bladder disturbances are late findings.In the acute phase of spinal cord injury, patients can develop spinal shock with absence of reflexes and flaccid paraplegia as a result.