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A 53-year-old man presents with flaccid paraparesis and sphincter dysfunction which developed gradually over 4 months. MRI imaging of the spinal cord and cauda equina is unremarkable. His past history is significant for hyperlipidemia, hypertension, and a history of testicular cancer treated with orchiectomy and radiation 14 years ago. Complete blood count and differential are normal. What is the most likely cause of his symptoms?
Explanation
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Cauda equina syndrome and myelopathies may occur as a delayed injury after radiation therapy. This is most commonly seen following radiation for testicular seminoma or lymphoma and occurs at a mean interval of 15 years after the radiation exposure. The spine imaging for this patient did not show evidence of an epidural abscess or other source of compression or inflammation
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Reference
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Page 155,Tarulli AW. Disorders of the cauda equina. Continuum (Minneap Minn). 2015 Feb21(1 Spinal Cord Disorders)146-58. doi 10.121201.CON.0000461090.09736.45. PMID 25651223.
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Option 1
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Is Correct (Option 1):
Epidural abscess
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Option 2
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Is Correct (Option 2):
Herpes zoster myelitis
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Option 3
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Is Correct (Option 3):
Neuromyelitis optica
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Option 4
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Is Correct (Option 4):
Radiation injury
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