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MRI lumbosacral spine and Muscle biopsy. A) Pre-contrast MRI lumbosacral spine showing no hyperintensity signal B) post-contrast MRI showing cauda equina nerve roots enhancement. (C-F) Partial denervation with myopathic change. C) (H&E-x200) shows scattered angulated, degenerated, and regenerated fibers (arrow); D) shows (H&E-x400) many degenerating fibers E) Myosin heavy chain (MHCs) shows atrophic angulated fibers (arrow) F) Succinic dehydrogenase (SDH) shows target/targetoid fibers.
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The muscle biopsy showed several angulated fibers and target and targetoid fibers, which were suggestive of neuropathic (denervation) pathology (Fig. 1, C-F); additionally, there were many degenerating and few regenerating fibers, which are considered secondary myopathic changes (Fig. 1, C-F).