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A man in his 70s was initially admitted under the orthopaedic service with subacute lower back pain radiating to his hips. Spinal MR imaging 3 months after symptom onset showed moderate lumbar canal stenosis at L4/5 with subtle central lower spinal cord and conus T2 hyperintensity, which was initially reported to be normal (figure 1). There was no improvement following L4/5 surgical decompression. His clinical syndrome progressed and 20 weeks after symptom onset he was bedbound with severe paraparesis. His care was transferred to the neurology service. MR scan of spine (figure 2) showed a longitudinally extensive T2-hyperintensity from T10 to the conus, and a non-enhancing syrinx-like central spinal cystic cavity from T3 to T10 without vascular abnormalities. Because an inflammatory myelopathy was considered most likely, we gave a course of steroids, with initial clinical improvement that was not sustained. Cerebrospinal fluid …
Footnotes
Contributors AB-N: study conception, drafting and revision NI: data acquisition and revision. WC: data acquisition and revision. OA: study conception, drafting and revision. TYW: study conception, drafting and revision.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally reviewed by Shelley Renowden, Bristol, UK.
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