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Neurology Case: The Losses in Lucy's Legs
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BACKGROUND

Lucy is a previously healthy, 36-year old woman, who has noted increasing weakness in her legs over the past month. She is now unable to walk without assistance. One yer ago, she noted paresthesias in her feet, which have progressively worsened. More recently, she has had tingling in her hands. She has had no back or neck pain. She has noted increased urgency to urinate, and has been incontinent on 2 occasions.

Examination reveals a normal mental status and cranial nerves. Arm strength is normal. Legs are stiff and moderately to severely weak: she is able to stand in a sitting position only with assistance. Her gait is also stiff and narrow based, and unsteady, and she tends to circumduct her legs. When she closes her eyes she falls forward. Light touch and pain perception are normal. Both joint position sense and vibratory sensation are diminished in the arms and legs. Deep tendon reflexes are increased in the arms and at the knees, but are absent at the ankles. Babinski signs are positively bilaterally.

QUESTION:

1. What is the specific location of the lesion in the central nervous system?

2. What is the most likely type of lesion (i.e. tumor, tosin, disease, vessel blockage . . .)

Optional Information:
Female