Gadolinium enhancement in cervical dorsal roots in a patient with acute autonomic and sensory neuropathy: a case report

Abstract

Background We report an enhancement of the dorsal roots on gadolinium-enhanced cervical magnetic resonance imaging (MRI) in a patient with acute autonomic and sensory neuropathy (AASN). Case presentation A 38-year-old woman visited our university hospital for dizziness and fainting while rising from sitting or lying down and a tingling sensation in the whole body, including her limbs, torso, and abdomen, which was sustained for 15 days. The patient had hyperalgesia in nearly her entire body and slight motor weakness in her bilateral upper and lower limbs. Autonomic dysfunction was confirmed using autonomic testing. Furthermore, the nerve conduction study showed an absence of sensory nerve action potentials in all evaluated peripheral nerves. Cervical MRI was performed 18 days after dysautonomia onset. In the axial T1-gadolinum-enhanced MRIs, enhancement in cervical ventral and dorsal nerve roots and the posterior column of the spinal cord were observed, and the axial T2-weighted MRI showed high signal intensity in the posterior column of the cervical spinal cord. Considering the clinical, electrophysiological and imaging findings, the patient was diagnosed with AASN. A total dose of 90 g (2 g/kg) of intravenous immunoglobulin was administered over 5 days. At the follow-up at 4 years after AASN symptom onset, the hyperalgesia and orthostatic hypotension symptoms improved. However, her systolic blood pressure intermittently decreased to < 80 mmHg. Conclusion Gadolinium-enhanced MRI may facilitate the accurate and prompt diagnosis of AASN.

Five Cases of Idiopathic Sciatic Mononeuropathy: Clinical, Electrophysiological, Radiological, and Histological Features

“…But electrophysiological and imaging data were not described and 6 out of 12 patients who underwent nerve biopsy showed findings of demyelinating neuropathy. In a case of neuralgic amyotrophy reported by Kim DH[ 5 ], electrophysiology showed active denervation in L5-S1 roots with imaging showing gadolinium enhancement with increased intensity in L5-S1 roots. In the present study, four of five cases, clinical, electrophysiological, and imaging findings localized the pathology at the sciatic nerve.…”