Images in Neuroscience: Question| Volume 16, ISSUE 12, P1608, December 2009

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Weakness and sensory disturbance of the left extremities

      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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      Fig. 2MRI of the cervical spine and intrathecal nerve roots before therapy. (A–C) Axial MRI at the C6 level. (D–F) Sagittal MRI of the cervical spinal cord. (A) and (D) are T1-weighted MRI; (B) and (E) are contrast-enhanced T1-weighted MRI; (C) and (F) are T2-weighted MRI.
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