Case 419

Female, 24 years, complaining of urinary retention, saddle anesthesia and hypoesthesia in the posterior regions of the leg and laterally of the foot bilaterally, more pronounced on the left, with 12 hours of evolution. Reports continuous burning pain in the L5 dermatome region on the left for 2 months, with progressive involvement of the contralateral limb in the same topography. Brings Magnetic Resonance Imaging (MRI) performed 1 month ago. On phisical examination, positive Laségue sign, patellar hyporeflexia, and absence of bilateral Achilles reflex.

Image 1: Magnetic resonance imaging (MRI) of the lumbosacral spine T2-weighted, sagittal plane, without paramagnetic contrast.

Image 2: RMI of the lumbosacral spine T2-weighted, axial plane at the height of L4 and L5, without paramagnetic contrast.

Question:

Considering the clinical findings and MRI images, what is the underlying condition of the syndrome presented and the appropriate therapeutic approach for the case, respectively?

Residency with Prerequisite, Neurosurgery/Neurology - Medical Association of Rio Grande do Sul

A 34-year-old male patient comes to the consult complaining of pain in the left lumbar region with irradiation to the lower limb on the same side. On physical examination is observed: bilateral contracture of paravertebral lumbar muscles, positive Laségue's sign and decreased strength (grade 3) of dorsiflexion and extension of the hallux on the left. Given the above, among the diagnostic possibilities, the most likely is: