Urinary Retention and Episodic Paresthesias

A36-year-oldmanpresentedwith2weeksof episodicnumbnessandparesthesias inboth feet,with symptom-free intervalsbetweenepisodes.Episodesprogressed in frequencyand duration, occurring several times daily and lasting for hours. His symptoms were prominentafteractivityandreliably triggeredbystrainingwith urinationandterminatedby lyingsupine.Thepatientalso reported a 1-weekhistory of urinary retention requiring intermittent self-catheterization. Neurological examinations both during and between episodes revealed symmetric patellar and Achilles hyperreflexia with bilateral crossed adductor response, but otherwise the resultswere normal. A thoracic spine magnetic resonance imaging scan with fast imaging employing steady-state acquisition (FIESTA) sequences was obtained (Figure). A dynamic computed tomographic myelogram demonstrated a lesion compressing the dorsal spinal cord at the T7 level (Video). Video at jamasurgery.com