History: 30 years old. Progressive lower limb weakness and bowel dysfunction. Query cauda equina compression.
Findings: There is a longitudinally-extensive region of cord signal abnormality, extending from T7/T8 to the conus. The cord appears slightly expanded. There is no enhancement. No lesions are identified elsewhere in the spine.
At other levels, there are circumferential disc bulges at L3/L4, L4/L5, and L5/S1. At L4/L5 the disc contacts the descending L5 nerve roots bilaterally in the lateral recesses.
Note is made of a grossly-distended urinary bladder. Catheterization could be considered if the patient is unable to pass urine.
Opinion: Longitudinally-extensive cord lesion. Given the relatively recent history, an inflammatory cause is more likely than a neoplastic or infective cause. Brain imaging is suggested to seach for intracranial inflammatory lesions, and CSF analysis may be appropriate.