An obese woman in her thirties with a history of fibromyalgia syndrome (FMS), depression, polycystic ovarian syndrome, and diabetes mellitus presents to her local emergency department with one week of gradually worsening midline back pain. At first she thought the pain was a result of her FMS, but because it did not improve after a few days like it usually does, she saw a chiropractor, which also did not help. She finally went to her regular doctor, who prescribed hydrocodone/acetaminophen and cyclobenzaprine; neither has helped her.
Over the past 24 hours, the patient has been constipated and has had difficulty with urinating. Both legs have started to feel “wobbly” and numb. The pain extends from below her neck down to her waist in the midline; it seems to move around some but usually is worst “just above her bra strap.”
The patient has no additional complaints and states that this episode definitely is not like her typical FMS attack.
A radiologist orders a CT scan, deferring an MRI until morning "if needed."