Intraspinal endometriosis as a possible cause of recurrent back pain and leg monoparesis

Recurrent back pain and leg monoparesis in a 38 year old woman could be traced back to a focus of intraspinal endometriosis. Upon admission, neurological examination revealed multiple sensory deficits and a proximal spastic paresis of the left leg. The patient complained about backache, which spontaneously disappeared some days later. History taking disclosed a relationship between the transient symptomatology and the menstrual cycle. Magnetic resonance imaging of the spine demonstrated a signal-intense intraspinal structure at the Th 8/9 level on the 25th day of the menstrual cycle. On follow-up examination at the beginning of the cycle the previously detected structure had vanished. Intraspinal endometriosis was confirmed by gynecological demonstration of additional endometriosis of the left ovary as well as positive response to treatment with a gonadotrophin releasing hormone analog.