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Clinical Reasoning: A case of slowly progressive painful paraparesis

In 2003, a 50-year-old woman was admitted to the emergency department of a large hospital for a 2-month history of stabbing epigastric pain radiating backward to the right scapula. The pain was not relieved in any position and was not preceded by fever or trauma. Her history was unremarkable. General examination including temperature, pulse, and blood pressure was normal.