A 71-year-old woman presented with progressive weakness and paresthesia of the left extremities that had started 2 months earlier. Physical examination showed a rash on her left palm. Fig. 1 shows the X-ray of the chest on admission. Neurological examination revealed weakness and sensory disturbance of the left extremities, hyporeflexia of the lower extremities, neurogenic bladder, and constipation. She had no headache or nuchal stiffness. Nerve conduction studies of her left extremities were nearly normal with only slightly low amplitude and those of her right extremities were normal. Laboratory tests revealed pleocytosis and elevated protein levels in cerebrospinal fluid, and elevated serum angiotensin converting enzyme levels. Cervical MRI is shown (Fig. 2).
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Accepted: December 8, 2008
Received: July 15, 2008
© 2009 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.