Question

A 72-year-old woman was referred to a neurologist with 13 months of progressive gait difficulty, right leg numbness, and urinary problems. She was in good health and walked several miles per day until she began noticing mild gait unsteadiness and bilateral leg stiffness, feeling her feet were not fully under her control. Her right leg gradually became weaker than her left. Her left leg developed progressive numbness and tingling, and she had intermittent right-sided thoracic back pain. Finally, she had increasing urinary frequency, occasional urinary incontinence, and difficulty completing a bowel movement. Neurologic exam (important features): Muscle tone increased in right leg 4/5 strength in right iliopsoas Stiff-legged, unsteady gait Pinprick sensation decreased on left side below the umbilicus Vibration and joint position sense decreased in right foot and leg Impaired bowel/bladder function Is this a lesion in the CNS or the PNS? Explain why.

          A 72-year-old woman was referred to a neurologist with 13 months of progressive gait difficulty, right leg numbness, and urinary problems.  She was in good health and walked several miles per day until she began noticing mild gait unsteadiness and bilateral leg stiffness, feeling her feet were not fully under her control.  Her right leg gradually became weaker than her left.  Her left leg developed progressive numbness and tingling, and she had intermittent right-sided thoracic back pain.  Finally, she had increasing urinary frequency, occasional urinary incontinence, and difficulty completing a bowel movement. Neurologic exam (important features): Muscle tone increased in right leg 4/5 strength in right iliopsoas Stiff-legged, unsteady gait Pinprick sensation decreased on left side below the umbilicus Vibration and joint position sense decreased in right foot and leg Impaired bowel/bladder function
Is this a lesion in the CNS or the PNS?  Explain why.

Added by Patricia K.

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