Sudden spasms following gradual lordosis--the stiff-person syndrome.

BACKGROUND

A 28-year-old woman presented to hospital after an episode of severe lower back spasms that occurred during a stressful family gathering. She had a history of progressive difficulty bending forward and increasing lumbar lordosis.

INVESTIGATIONS: Physical examination, spine MRI scan, abdominal and pelvic ultrasound, electromyogram, nerve conduction studies, cerebrospinal fluid analysis, breast examination, Pap smear, transabdominal and endovaginal ultrasound.

DIAGNOSIS: Stiff-person syndrome with high titer of antibodies against glutamic acid decarboxylase.

TREATMENT: Benzodiazepines and intravenous immunoglobulins.