doc26inder
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A 73-year-old woman presents with a 6-month history of deteriorating gait and low-back discomfort, exacerbated by walking. Examination is unremarkable except for hypoactive muscle stretch reflexes in the legs. X-rays of the lumbosacral area show the expected degenerative changes associated with a woman of her age. Which one of the following is the most likely diagnosis?
1) acute lumbar disk herniation
2) lumbar stenosis
3) myopathy
4) normal pressure hydrocephalus (NPH)
5) cervical stenosis
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| cam
Forum Senior
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2?
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| drkpp
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2. lumbar stenosis seems to be the most likely answer here..
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| merrk
Forum Elite
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I agree. pain exacerbated by walking. diagnosis by CT or MRI.
Treatment is surgery.it is the most frequent indication for spinal surgery in patients older than 65 years. Surgery is usually recommended when symptoms, particularly pseudoclaudication, fail to respond adequately to nonsurgical care.
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| chemamr
Moderator and PGY1
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i would put 2.
But, please explain why is it not number 1 (besides that it says acute)?
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| adeelmd
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"if pain is not exacerbated by coughing, sneezing, or defecation, it is not disk herniation" Also, they would have vague discogenic pain (asl) for several months before having shooting pains going down the leg, straight leg raising test are not described..Peak age of incidence is also 45-46
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