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A 72 year-old woman presented with progressive pain, weakness and sensory loss in the left leg. Her examination showed an absent left ankle reflex, and distal weakness and numbness.
(Left) Axial MRI scan T2-weighte imaged; (Right) Sagittal MRI scan T1-weighted image. Note on the left scan, the markedly enlarged nerve root (red arrow) compared to the normal size of the other nerve roots in the cauda equina. On the right scan, the normal exiting nerve roots can be seen surrounded by epidural fat. However, the nerve root exiting below the L5 pedicle is markedly enlarged, filling the foramen. Biopsy demonstrated infiltration of the nerve roots by malignant lymphoma. It is important to reminder that radiculopathy can be caused by external compression (e.g., disk, spondylosis) but can also be caused by infiltration of tumor or granulomatous tissue.
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