Presumed Acute Leukemia Presenting as Acute Spinal Cord Injury

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A 22-yr-old man with no significant medical history presented with acute onset of paraparesis and bowel and bladder incontinence, occurring after a fall down four steps. Physical examination was remarkable in the bilateral lower limbs for strength 0/5, absent light touch, pinprick, and reflexes. International standards for neurological classification of spinal cord injury examination was consistent with a T5 AIS A spinal cord injury with no zone of partial preservation. Computed tomography abdomen/pelvis showed no bony abnormality or acute fracture but a high density of the spinal cord at T7–T12 levels with possible intradural or epidural cord compression. Follow-up magnetic resonance imaging of the thoracic spine showed an epidural hematoma at T5–T12, worst at T9–T11 with evidence of spinal cord compression (Fig. 1). Abdominal imaging further showed organomegaly consistent with lymphoma/leukemia. Laboratory results were significant for a leukocytosis of 169,000/μl and thrombocytopenia of 22,000/μl. These findings were consistent with a concurrent presentation of spinal cord injury and acute leukemia. The patient was transferred to another institution for final oncologic diagnosis and treatment and lost to follow-up.

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