History: A 43-year-old man with a history of alcohol addiction is transported to the emergency department by ambulance for bilateral leg weakness following a presumed seizure. The patient is no longer post-ictal and states that unlike prior seizures from alcohol withdrawal, this time he was unable to walk normally after he woke up. He says the difficulty walking is due to weakness in both of his legs. He admits to some mild chronic back pain, which he reports is no different from its baseline. He denies any fever, neck, or leg pain or numbness, headache, bowel or bladder problems, vomiting, or other complaints.
Examination: Vital signs show a temperature of 98.9°F, BP 162/93 mm Hg, and pulse of 112 beats/min. He has no spinal tenderness and his straight leg raise test is normal bilaterally. On strength exam he is 4-/5 in both legs and 5-/5 in both arms. He is also noted to have brisk deep tendon reflexes (DTRs), especially considering his chronic alcohol use, which is known to be associated with decreased DTRs.
Laboratory values: K = 3.3 mEq/L; Na = 146 mEq/L; Hb = 10 g/dL. Other basic lab results are unremarkable.
Initial concern(s): Electrolyte abnormality, spinal cord compression, stroke, trauma
What additional testing should be ordered?
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