16th August 2024

A 74-year-old female is referred urgently by the GP to you with progressive leg weakness

A 74-year-old female is referred urgently by the GP to you with progressive leg weakness. She has had no contact with healthcare services for some years and has just been visited by her daughter for the first time in many years, who found her bedbound and incontinent.

She has long complained of altered sensation and numbness in the legs, but these had been put down to being a result of her poorly controlled diabetes.

On examination, you note hypertonia with reduced power in the lower limbs, right worse than left. The reflexes are brisk, and the plantars are upgoing.

An urgent MRI of the spine demonstrates a homogeneously contrast enhancing mass posterolateral to the cord in the thoracic spine, demonstrating cord compression, but no bony changes or local invasion.

Which is the single most likely diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.