32 yr of male pt present with LBA n weakness of both LL. No sensory disturbances. All physio modalities tried but no improvement. MRI REPORT normal study.Can anyone can give your suggestions.

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Patient is very young, needs urgent proper evaluation. Ref to neurologist for working diagnosis. How is the onset in acute/ subacute/ chronic?. Duration of symptoms? What about the motor power? What about the DTRS.? Bowel or bladder functions intact or not ?. What was your diagnosis before doing MRI?.Any loss of wt or appetite? Any symptoms suggestive of vasculitis? Weakness with back pain can occur in several conditions. Muscle disorder,peripheral neuropathy Polyradiculopathy,spinal problem with cauda conus lesions,spinal cord lesion above D12 ,secondary to other systemic illnesses etc. So needs good history and physical exam findings for proper discussions

Symptoms has to be taken seriously We could be missing something From visualized images,suspicious extradural shadow posterior to cord at D5 level. Need detailed study at the level Contrast enhancement may help

Need axial MRI cuts,,, also a more detailed clinical findings, like exactly which joint movts are weaker? bilateral plantar reflexes? acute onset or chronic history, etc,,,,, a CT brain image if possible,,

after seeing this saggital section its looks like low lying cord..kindaly review reporting from other Radiologist and send axial section of T1 images if possible

do mri brain screening.. to r/o falx meningioma like lesion before starting steroid

if MRI is normal then there might be another reason of weakness. neuropathy, myopathy. emg/ncv may help.

Was GB syndrome ruled out

chek for the facet joints of the lumber spine and extensor muscle tones..and do postural correction of patient..start with back extention exercises of the patient and ergonomical correction if needed..

Try with manual therapy it works fantastic and gives hopes to our clients Check for stiffness in effectors,quadratic. Triggers point release therapy. Dry needling for stiff and triggered muscles Followed by stretches

most probably transverse mylities. do csf . NCV. give methyl prednisone

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