Presentation
Progressive peripheral neuropathy on a background of Waldenström's macroglobulinemia.
Patient Data
Smooth enhancement of the cauda equina nerve roots. No nerve root clumping. Normal appearance of the spinal cord.
Diffusely reduced bone marrow signal intensity in keeping with increased hematopoiesis/bone marrow infiltration.
Case Discussion
In the setting of Waldenström macroglobulinemia, the finding of smooth enhancement of the cauda equina is consistent with Bing-Neel syndrome. This is a rare neurologic complication of this disease resulting from direct infiltration of the CNS by lymphoplasmacytic cells. The differential (in a different clinical scenario) would be Guillain-Barré syndrome.
CSF studies showed increased protein and a cell population suspicious for a B-cell lymphoproliferative disorder, confirming the diagnosis.
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