79‐Year Old Man with Parkinsonism and Acute Spinal Cord Compression

A 79-year-old man presented with a two month history of worsening back pain, urinary dysfunction and bilateral leg weakness. His past medical history included a childhood diagnosis of a metabolic disorder, which over the course of his life had manifested with hepatosplenomegaly, bone pain and osteoporosis. Seven years ago he was also diagnosed with prostatic carcinoma that had been managed conservatively. More recently he developed cognitive dysfunction and Parkinsonism and was awaiting neurocognitive assessment. On neurological exam he was alert but mildly cognitively impaired with some Parkinsonian signs. Motor examination uncovered increased tone, hyperreflexia, clonus and significant weakness in his lower limbs (unable to overcome gravity). His sensory exam showed bilateral lower extremity loss of vibration sense. MRI of the spine showed widespread signal change in the bone marrow and a pathologic compression fracture of L1 with retropulsion of the posterior aspect of the vertebral body into the anterior spinal canal compressing the cord at the level of the conus. He underwent L1 laminectomy, vertebrectomy and cord decompression with vertebroplasty. Intraoperatively the resected vertebral body appeared abnormal, and was sent to pathology labelled “query metastatic carcinoma”.