New Symptoms in Old Illness

Abstract

75-year-old man with ankylosing spondylitis (Bechterew’s disease) was admitted with walking difficulties. Symptoms had gradually progressed over the period of 2–3 years. There was bilateral leg weakness, with left leg being described as “less reliable” than the right. Patient had suffered from ankylosing spondylitis for decades and for last 2 years he had been off all treatments. In the past whole spine “irradiation” was used (no further information had been available, historical notes also not available). On objective examination we found paraparesis/weakness with prevalence on the left (4/5 vs. 4+/5 on the right). There was hyperreflexia in legs with clonus in left ankle. Patient had obvious sphincter problems (having catheter for more than 3 years for retention- so likely pre-dating walking issues). There was light touch hypoesthesia in lower extremities and loss of vibration sense, there was not any sensory level on trunk. Plantars were positive/extensor. Findings in upper extremities were normal. Cranial nerves and cerebellar functions were unremarkable as well.