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تغيرات تنكسية


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حالة سريرية

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An 80-year-old woman complains of a 4 month history of worsening gait and low back pain
that is worse on walking. She denies any trauma and is not incontinent. She has been fairly
healthy and only takes iron supplements. On examination, she has hypoactive muscle stretch
reflexes in the legs. The plain x-rays of the lumbosacral region show degenerative changes
that seem age-appropriate. Which of the following is the most likely diagnosis?
A. Acute lumbar disc herniation
B. Cervical stenosis
C. Lumbar stenosis
D. Myopathy
E. Normal pressure hydrocephalus (NPH)

by


c

DAM's picture
DAM


I also Say C

Dr.Falcon's picture
Dr.Falcon
السنة الخامسة

The correct answer is C. Lumbar stenosis is caused by degenerative changes in the
lumbosacral spine. The history is that of vague low back pain with subtle physical
examination findings referable to impingement on motor and sensory roots
.
Acute disc herniation (choice A) is characterized by low back discomfort and pain
extending in a radicular fashion. Examination is consistent with impingement on a single
sensory or motor root.
Cervical stenosis (choice B) can cause a myelopathy and resultant gait problem, but
this patient has degenerative changes in the lumbosacral region.
Myopathy (choice D) can cause an impaired gait, low back discomfort and hypoactive
muscle reflexes, typically at the knee
. Weakness tends to be symmetric and proximal.
NPH (choice E) causes an apraxic gait, dementia and urinary incontinence.
qusei
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