Case Presentation:
A 70-year-old right-hand dominant Asian female presented
with progressive bilateral lower extremity weakness, tingling sensation,
and numbness over ten months of duration. At the time of the
presentation, she was unable to walk on her own and was
wheelchair-bound. She further complained of urinary incontinence and
constipation. There was no associated fever, dizziness, blurring of
vision, auditory abnormalities, speech abnormalities, weakness in the
upper limbs, and history of trauma. She has a history of hemorrhoids and
mild aortic regurgitation. She is currently not under any medication and
doesn’t have an account of surgical intervention in the past. She
doesn’t have a significant history of known allergies or similar
illnesses in her family members.
On physical examination, her vitals were within the normal limits. A
neurological examination revealed decreased muscle strength on her
bilateral lower limbs with a power of 3/5 bilaterally. Deep tendon
reflexes were hypoactive in her lower limbs and normal in the upper
limbs. There was decreased touch and pain sensation in the bilateral
lower limbs. Her PCR for SARS CoV 2 was negative, and her blood reports
were normal.
An MRI of the thoracolumbar spine (plain and contrast-enhanced) was
done. The MRI revealed an ill-defined heterogeneously enhancing lesion
in conus medullaris with dural enhancement likely to be myxopapillary
ependymoma.