Paraneoplastic encephalomyelitis

Acute or subacute myelopathy may occur as a complication of systemic malignancy similar to limbic encephalitis.

Clinical history
This 46-year-old male patient had a well known malignant lymphoma treated recently by plasmapheresis. Recent major clinical deterioration with motor and sensory deficit as well as rapid progression of coma.

MRI findings
Image 1: Sagittal T1WI. No signal abnormalities are seen within a mildly expanded upper thoracic cord.
Image 2: Sagittal T2WI. An anterior high intensity lesion is seen at the level of T2-T4. (arrows).
Image 3: Sagittal Gd T1WI. After contrast administration, moderate but definite enhancement is seen.
Image 4: Axial Gd T1WI. Enhancement is located within the anterior two thirds of the medulla (arrows).

Conclusion
Acute spinal cord ischemia in a patient with hemopathy. The patient died a few days later and the diagnosis was confirmed at autopsy.

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