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Gadolinium enhancement of the lumbar roots in a case of ALS

We present a single case of clinically definite amyotrophic lateral sclerosis (ALS) associated with modest gadolinium enhancement of the lumbar nerve roots without thickening or nodularity and with CSF protein elevation (80 mg/dl). These findings should not exclude a clinical diagnosis of ALS and suggest that the enhancement of nerve roots and protein elevation were related to rapid neuronal degeneration, not inflammation.