Acute Spinal Rigidity
A 69-year-old woman presented with a 1-year history of low back and leg pain accompanied by progressive difficulty walking. Lumbar surgery was undertaken for spondylolisthesis and canal stenosis. Postoperatively, the pain improved but her walking continued to deteriorate. She then developed spasms of the back and right leg causing flexion of the trunk, hip, and knee. Her mobility deteriorated further. Examination at this time revealed a rigid right leg with palpable muscle activity in all muscle groups, brisk tendon reflexes, and an extensor plantar response. There was no truncal rigidity. There was no sensory loss, but sensory stimulation elicited a brisk flexion withdrawal movement of the whole leg. Similar flexion spasms of the leg and hip were evident while walking and severely restricted her gait. Further imaging of the whole spinal cord was normal. A glucose tolerance test was abnormal, but anti-glutamic acid dehydrogenase (anti-GAD) antibodies were not detected. Baclofen was prescribed with some improvement in the rigidity and mobility. One year later, her mobility declined again. Examination on this occasion revealed abdominal wall and lumbar paraspinal rigidity along with bilateral leg rigidity. The clinical picture was now that of the stiff-person syndrome, although anti-GAD antibodies remained negative.
KeywordsIntrathecal Baclofen Extensor Plantar Response Spinal Rigidity Spinal Grey Matter Motor Neuron Syndrome
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