Clinical Reasoning: A 45-year-old woman with immobility and incontinence

A 45-year-old woman presented with immobility and incontinence in July 2016. Her symptoms started 6 months prior to presentation, when she had multiple falls (without major injuries) at home because of weakness in the lower extremities. She experienced urinary incontinence 1 month later. An indwelling catheter was placed and clamped every 2–3 hours in the daytime and kept open during the night. Later, she preferred not to walk for fear of falling. The patient started to feel stiffness and tightness in her lower extremities 3 months later. The condition worsened gradually to the extent that she could barely move her lower extremities in bed and reported it affected her sleep recently. Along with motor dysfunctions, she also experienced numbness in her lower extremities, but denied pain. She was able to sit in a wheelchair for 7 hours per day. A pressure ulcer was noticed in the sacral region 4 months later. She denied other discomfort. Her appetite has been good. She had no significant weight changes during the last half year.