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CIDP Causing Cauda Equina Syndrome

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If we look at this patient who

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has a cauda equina syndrome,

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we note that there are markedly enlarged nerve

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roots throughout the cauda equina.

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Here we have the spinal cord coming down,

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which looks fine.

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No abnormality in the signal intensity of the spinal

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cord, but we have this thickening of the nerve roots.

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This is confirmed on the axial scans through the

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lumbosacral region, and the nerve roots are enlarged.

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Not only that,

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but we see that there are enlarged neuroforamina with

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nerve roots coming out, and once again appearing to be

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within the psoas muscle and then extending

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into the lumbosacral plexus.

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This is actually coming from the sacral neuroforamina,

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which are also markedly enlarged here.

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So in this case,

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the patient did not have contrast ordered.

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We brought the patient back later in

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the day to administer contrast.

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Why would we care about the contrast?

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Well, certainly in our differential diagnosis of things like

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subarachnoid seeding or neurofibromatosis

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or an infectious etiology, sarcoidosis,

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noninfectious inflammatory etiology,

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we would expect to see contrast enhancement.

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So the contrast enhanced study was performed.

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As you can see,

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this was done postgadolinium with fat suppression,

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fat-suppressed on the T1-weighted scan,

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and there is absolutely no enhancement of

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the nerve roots here on the axial scans.

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Although this is a little bit of dark,

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we don't see any enhancement.

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We see the enlargement of the neuroforamina and nerve

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root sleeves and the nerves out into the periphery,

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but none of them are enhancing.

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So that effectively rules out subarachnoid seeding, neurofibromatosis,

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infectious etiologies.

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This was another patient who had CIDP,

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and CIDP may or may not show contrast enhancement.

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Be careful with CIDP because often the patients will

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have at least a course of steroids for a therapy.

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And if that is administered,

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it may suppress the gadolinium enhancement

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that may occur with CIDP.

Report

Description

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Spine

Non-infectious Inflammatory

Neuroradiology

Musculoskeletal (MSK)

MRI

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