Male, 33 years old, with worsening quadriparesis and spasms. Cervical:Patchy T2 hyperintensity persists within the cervical spinal cord without significant cord expansion and no definite associated cord enhancement. Findings are similar to the prior exam. However, on postcontrast images, all of the dorsal and ventral nerve roots arising from the cervical region are enhancing. This finding was not clearly present on the prior study.No marrow signal abnormality is detected. Vertebral body morphology and alignment are normal. No evidence of significant spinal canal or neuroforaminal stenosis is seen.Thoracic:Patchy T2 hyperintensity is redemonstrated throughout the thoracic spinal cord. This is most conspicuous at the T7 through T9 levels. The degree of this signal abnormality may be mildly increased compared to that seen on the prior study, although this appearance could in part be due to technical differences. No definite pathologic cord enhancement is seen.Although not as clearly seen as in the cervical region, most of the thoracic nerve roots are enhancing, particularly those giving rise to the cauda equina. Again, this finding was not as well visualized on the prior study.The thoracic kyphosis is mildly exaggerated. In addition, there are Schmorl's node deformities and end plate undulation from T6 through T9 along with mild anterior wedging. No pathologic marrow signal abnormality is seen.At T8-9, there is a central disk protrusion which mildly impinges upon the ventral spinal cord. Elsewhere, no significant disk disease, spinal canal or neuroforaminal stenosis is detected.
Patchy cord signal abnormality is again seen, without significant change from the prior examination.Diffuse enhancement of the cervical and thoracic nerve roots is new or progressed from the prior study.The differential diagnosis would include a post infectious autoimmune phenomenon as the most likely etiology. Noninfectious inflammatory etiologies may also be considered, with ongoing atypical or viral infection a less likely possibility. Findings in the thoracic spine suggestive of Scheuerman's disease. Also noted is a central disk protrusion at T8-9 which impinges the spinal cord.