Case of December 2009

Clinical History:

A 45-year-old gentleman with good past health presented with progressive left-sided weakness and bilateral hand clumsiness for a few months.  He has no headache, no diplopia nor swallowing problem. On neurological examination, a neurologically sound patient was found to have muscle wasting over bilateral first dorsal interossei, increase tonicity of bilateral lower limb and the presence of left ankle clonus. Limb power is diminished with MRC grading 4/5 over left upper and lower limbs.  MRI spine was performed.

                           Fig 1. T2 Sagittal                                                        Fig 2. T2 Axial

                                                                                                Fig 4. Postcontrast T1 Sagittal with 

                             Fig 3. T1 Sagittal                                                          fat saturation