Abstract
This case presents a 43 yr old woman with an eight-week history of progressing leg weakness set against a long history of chronic back pain. She was referred to the Orthopaedic department following referral from her General Practitioner. The weakness became so distressing to the patient that it resulted in a prior attendance at an Accident & Emergency department. The case illustrates the complexities of clinical reasoning within the area of serious pathology of the spine. It demonstrates the importance of detailed subjective history questioning in the quest for early diagnosis, which is particularly important for clinicians who work in an autonomous or extended role.