Clinical reasoning: a 59-year-old woman with acute paraplegia.
Case presentation. A 59-year-old woman with a history of hypertension developed acute bilateral flaccid leg weakness while watching television. She had shifted her weight while sitting on the couch and suddenly felt a sharp pain in her lower back and right leg. When she stood up to walk she noticed that her legs were numb; over the course of 1 hour she became unable to move her legs. She could not urinate voluntarily, and had dribbling incontinence. She was brought to the emergency department for evaluation. 1. Where does acute paraplegia localize and what is the differential diagnosis? 2. What features of the history help make certain entities more or less likely? Address correspondence and reprint requests to Dr.