Medical Board Question, Can You Get It Right and What was the Cause

[gator1776]

A 29-year-old woman presents to the emergency department with a 3-day history of progressive weakness, sensory loss in her lower extremities, and urinary incontinence. The patient is healthy with no medication use other than her flu vaccination obtained 2 weeks prior. On physical exam, her cranial nerves are intact, she is profoundly weak in all extremities with 2 out of 5 motor strength on MRC scale, and she is areflexic. All modalities of sensation are profoundly decreased below the neck. Vital signs: blood pressure 84/45 mmHg, pulse is 52/min, respirations are 12/min, and oxygen saturation is 91%. A sagittal T2 and post contrast T1 cervical spine MRI are shown. Which of the following is the most likely diagnosis?

A. Anterior spinal cord infarct
B. Copper deficiency
C. Guillain-Barre syndrome
D. Transverse myelitis
E. Vitamin B12 deficiency

Just for fun, lol

 

[DCandtheUTBand]

My guess is D probably from the vaccine causing inflammation and the pre-existing injury.

If its then D do you do a steroid shot, prednisone or some other treatment?

 

[gator1776]

My guess is D probably from the vaccine causing inflammation and the pre-existing injury.

If its then D do you do a steroid shot, prednisone or some other treatment?

There was no pre-existing injury
But the answer is D, it is transverse myelitis as demonstrated on the MRI of the spine.
It is one of the exceedingly rare complications of vaccinations, which is why I thought this group would love this one.
And IV steroids remains the first line treatment

 

[DCandtheUTBand]

There was no pre-existing injury
But the answer is D, it is transverse myelitis as demonstrated on the MRI of the spine.
It is one of the exceedingly rare complications of vaccinations, which is why I thought this group would love this one.
And IV steroids remains the first line treatment

OK, assumed the areflexia was due to an injury. I couldn't read an MRI although the one of my wifes neck was obvious in the narrowing. She had CV surgery. A Johns Hopkins grad working at Vandy.

 

[gator1776]

OK, assumed the areflexia was due to an injury. I couldn't read an MRI although the one of my wifes neck was obvious in the narrowing. She had CV surgery. A Johns Hopkins grad working at Vandy.

Hope she is doing well.

 

[DCandtheUTBand]

Hope she is doing well.

4 years ago this month. She has residual nerve damage but is much better. She has regained strength in the affected arm and now has a normal gait again.

 

[Capt Ron 1]

A 29-year-old woman presents to the emergency department with a 3-day history of progressive weakness, sensory loss in her lower extremities, and urinary incontinence. The patient is healthy with no medication use other than her flu vaccination obtained 2 weeks prior. On physical exam, her cranial nerves are intact, she is profoundly weak in all extremities with 2 out of 5 motor strength on MRC scale, and she is areflexic. All modalities of sensation are profoundly decreased below the neck. Vital signs: blood pressure 84/45 mmHg, pulse is 52/min, respirations are 12/min, and oxygen saturation is 91%. A sagittal T2 and post contrast T1 cervical spine MRI are shown. Which of the following is the most likely diagnosis?

A. Anterior spinal cord infarct
B. Copper deficiency
C. Guillain-Barre syndrome
D. Transverse myelitis
E. Vitamin B12 deficiency

Just for fun, lol

Out of my league! LOL