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Phantom limb sensations after complete thoracic transverse myelitis

Phantom phenomena are common complications of limb amputations and may occasionally follow traumatic paraplegia and severe injuries of peripheral nerves. However, they have not been previously reported in patients with non-traumatic paraplegia. The following case history describes a patient with transverse myelitis resulting in complete paraplegia who experienced persistent movements and abnormal positions of her paralysed lower limbs. These findings suggest that disruption of the anatomical and functional integrity of the spinal cord may be the most important factor in the pathogenesis of phantom sensations.

A 61 year old woman presented with severe weakness of both legs, skin sensory loss and paraesthesia of the lower limbs, and bowel and bladder symptoms. She was well until 3 months earlier when she started to develop a tingling sensation and numbness over the outer side of her left leg. These symptoms gradually progressed and by the time she was admitted to hospital she had paraesthesia and sensory impairment of the whole of the left leg and in the distal half of the right leg. A month before admission she had become unsteady on her feet and developed urinary frequency, urgency of micturition, and constipation. There was also a rapidly progressive weakness of both legs, but no other symptoms.

Four years earlier the patient had had paraesthesia in both feet. This was thought to be due to peripheral neuropathy, but the diagnosis was not confirmed with neurophysiological tests. The symptoms resolved in a few weeks. The patient had …