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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).
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.
