MRI spine- Teaching case

This is a neuro image teaching case taken from neurology today. Read more..

A 79-year-old man with ulcerative colitis on chronic prednisone therapy developed severe midcervical pain and progressive weakness of the left arm and leg over several days. This was associated with left forearm paresthesias and urinary hesitancy and incontinence. He had no cranial or bulbar symptoms. On general examination, he was afebrile but there was midcervical spine tenderness. Neurologic examination revealed normal mental status and cranial nerves; strength was 2/5 on the left, and 4/5 on the right; there was a sensory level to pain and temperature on the right to C4, with reduced proprioception in the left foot and hand; there was a left Babinski sign and a mute right plantar response. White blood cell count was 18.2 x 109/L. Blood cultures were negative. Chest CT demonstrated multiple lung nodules.
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Open spinal cord biopsy revealed Nocardia farcinica abscess.