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Case 24

A 56 year old man with falls

This 56 year old man had a five year history of Parkinson's disease. Six months earlier he had been treated for septicaemia, and had made a full recovery.

Over recent weeks he had suffered an increasing number of falls. He was admitted and again found to be septicaemic, for which he was treated. However he also complained of pain in the groin, and was noted to have bilateral weakness and spasticity of the legs.

Investigations revealed a lytic bone lesion in the right superior pubic ramus. However X-rays of the spine were reported to show only some degenerative change in the cervical region.

An MRI of the spine was obtained to investigate his leg weakness.

What do you suspect? What might you do next?