PMC6515126_01
a) Spinal magnetic resonance imaging (MRI) scan obtained on the day of admission (day 4).. T2-weighted images of the lumber spinal cord show that longitudinal lesions are ill-defined and involve the central gray matter (arrow). Gadolinium-enhanced T1-weighted images show abnormal enhancement of the cauda equina, predominantly in the ventral roots (arrowheads). b) Spinal magnetic resonance imaging (MRI) scan obtained on day 27.. In this second MRI scan, spinal lesions appeared to have become well-defined and were confined to the anterior horn (arrow). The anterior dominant enhancement of the cauda equina remained (arrowheads).
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Spinal MRI and myelography (Fig. 1a) revealed no obvious bleeding or vascular disease. T2-weighted MRI from the day of admission by an experienced radiologist revealed extensive longitudinal lesions in the entire spine, predominantly in the central gray matter; smooth linear enhancement of the anterior cauda equina nerve roots was also observed (Fig. 1a). The patient was therefore diagnosed with AFM, based on the weakness of his legs, CSF pleocytosis, and MRI findings. Anterior dominant enhancement of the cauda equina was observed on the second MRI (Fig. 1b).
Follow-up of motor function and treatment.. The upper part shows the development of motor function over time. The motor function of the upper limbs improved, but the weakness of the lower limbs remained.. Rehabilitation continued after discharge from the hospital. The bladder and rectal disorders had improved before the discharge. The lower part shows the treatment course. Gamma globulin and steroid pulse were administered as shown.
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The course of treatment and order of tests performed post-admission are shown in Fig. 2.