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Images in Neurology
August 2001

Myelopathic Onychodystrophy

Arch Neurol. 2001;58(8):1292-1293. doi:10.1001/archneur.58.8.1292

A 20-year-old woman was admitted in April 1999 because of sudden neck pain, ascending paresthesias, and progressive weakness of the legs. Neurological examination revealed 3/5 strength throughout the legs, decrease of pain and discriminatory sensation below the level of T5, and incoordination of the upper extremities.

A spinal magnetic resonance imaging scan, obtained 24 hours after the onset of symptoms, showed a swollen cervical cord with multiple intramedullary areas of hyperintense signals on T2-weighted and proton density scans, spanning from C2 to C6. These lesions enhanced on T1-weighted scans after contrast administration (Figure 1A), and predominantly involved the left side of the spinal cord, as demonstrated by an axial study. Somatosensory evoked potentials, but not visual or brainstem auditory evoked potentials, were abnormal.

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