A 45-year-old male prison inmate presented with a 1.5-year history of back pain. He described progressive weakness and numbness in the lower extremities over the past 6 months. He deteriorated from walking unassisted to requiring a cane and now a walker. He could no longer climb stairs or stand from a squatting position without assistance. There was no bowel, bladder, or sexual disturbance. Neurological examination revealed a diffuse increase in tone in the lower extremities. Strength scores in the hip flexors, adductors, and abductors were 3 of 5 and knee flexors and extensors and foot dorsiflexors were 4− of 5. The left lower extremity was weaker than the right. Sensory examination revealed impaired light touch, pinprick, and temperature sensation below the level of T5 through T6 on the left. Patellar reflex was 3+ with crossed adductors bilaterally. He had a spastic gait with impaired knee flexion.
Shivaprasad S, Shroff G, Campbell GA. Thoracic Epidural Cavernous HemangiomaImaging and Pathology. JAMA Neurol. 2013;70(9):1196-1197. doi:10.1001/2013.jamaneurol.188