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JAMA Surgery Clinical Challenge
May 2015

Urinary Retention and Episodic Paresthesias

Author Affiliations
  • 1Department of Urology, University of Texas Southwestern Medical Center, Dallas
  • 2Department of Neurology, Case Western Reserve University, Cleveland, Ohio
  • 3Department of Neurology, University of Michigan, Ann Arbor
JAMA Surg. 2015;150(5):485-486. doi:10.1001/jamasurg.2014.1720

A 36-year-old man presented with 2 weeks of episodic numbness and paresthesias in both feet, with symptom-free intervals between episodes. Episodes progressed in frequency and duration, occurring several times daily and lasting for hours. His symptoms were prominent after activity and reliably triggered by straining with urination and terminated by lying supine. The patient also reported a 1-week history of urinary retention requiring intermittent self-catheterization. Neurological examinations both during and between episodes revealed symmetric patellar and Achilles hyperreflexia with bilateral crossed adductor response, but otherwise the results were normal. A thoracic spine magnetic resonance imaging scan with fast imaging employing steady-state acquisition (FIESTA) sequences was obtained (Figure). A dynamic computed tomographic myelogram demonstrated a lesion compressing the dorsal spinal cord at the T7 level (Video).