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An elderly man with slowly ascending numbness of the legs, followed by incontinence and paraplegia

Professor and Chairman, Department of Neurology, University Medical Centre, Heidelberglaan 100, 3581 CX Utrecht, Netherlands; J.vanGijn@umcutrecht.nl

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The patient was a modest 69 year old man, the retired director of a large firm. He consulted me in May 1984 because of trouble with his legs. This had started in December of the previous year, with altered sensation in his feet; at first they felt "itchy", then gradually "leathery". In February the back of his thighs had started to feel numb, later his left buttock as well. In the past month his sexual potency had decreased and he had twice been incontinent of faeces. On examination muscle power was completely normal. I confirmed decreased skin sensation in the feet, the back of the left thigh, and in the perineal region. Both ankle jerks were absent and the left knee jerk was decreased; the plantar responses were normal.

Given the combination of sensory deficits in sacral dermatomes and disturbances of voiding and erection, I suspected a problem in the . . . [Full text of this article]