PMC9977207_01
Prominent thenar and hypothenar atrophy of left hand (yellow arrows).
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FIG1
Examination of the upper limbs revealed forearm, interosseous, thenar, and hypothenar muscular atrophy and weakness (Figures 1-3).
Prominent thenar and hypothenar atrophy of right hand (yellow arrows).
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FIG2
Examination of the upper limbs revealed forearm, interosseous, thenar, and hypothenar muscular atrophy and weakness (Figures 1-3).
Prominent bilateral forearm muscle atrophy (yellow arrows), selective sparing of brachioradialis (green arrows).
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FIG3
Examination of the upper limbs revealed forearm, interosseous, thenar, and hypothenar muscular atrophy and weakness (Figures 1-3).
Atrophy of bilateral lower limb muscles, more marked in the calf muscles. Foot showing bilateral Hallux valgus deformity and clawing.
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FIG4
Clawing with the Hallux Valgus deformity was observed on both feet (Figure 4).
Normal appearing MRI sequence of the cervical region with a mild extension of the neck.
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FIG5
MRI of the cervical spine with screening of other regions was normal (Figure 5 and Figure 6), but a cervico-thoracic flexion MRI revealed forward migration of the posterior wall of the dura mater indenting the spinal cord from C7-D7 levels with prominent posterior epidural space with fat and flow voids.
Normal appearing MRI sequence of the cervical region with neck flexion.
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FIG6
MRI of the cervical spine with screening of other regions was normal (Figure 5 and Figure 6), but a cervico-thoracic flexion MRI revealed forward migration of the posterior wall of the dura mater indenting the spinal cord from C7-D7 levels with prominent posterior epidural space with fat and flow voids.
Flexion MRI sequence of thoracic spine showing increased posterior epidural space, further confirmed by contrast MRI showing increased venous prominence and posterior void (yellow arrows).
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FIG7
On contrast MRI there was prominent homogenous posterior epidural enhancement (Figure 7).