Carcinomatous Infiltration of the Cauda Equina

A 33 year-old man presented with progressive pain, weakness and sensory loss in both legs. His examination showed an absent reflexes in the lower extremities, paraparesis and decreased sensation in the lower extremities.

Show the Gadolinium Enhancement of the Roots

(Left) Axial MRI T1-weighted image; (Right) Axial MRI T1-weighted with GAD image. Note on the contrast scan on the right, all of the nerve roots enhance with gadolinium. The nerve roots are also moderately enlarged. Nerve root enhancement can be seen in a variety of inflammatory and infiltrative disorders, among these are included Guillain Barre syndrome and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). However, with nerve root enlargement and clumping, this is more likely infiltrative in nature. Subsequent evaluation demonstrated metastatic carcinoma of the stomach.

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