Presentation
Ascending paralysis with progressive loss of motor skills in the legs
Patient Data
There is T2 hyperintensity and enhancement of the left anterior horn cell at L2 with accompanying thickening and enhancement of the anterior nerve roots of the cauda equina. No focal mass lesion.
PCR on CSF from lumbar puncture
Enterovirus 71: +ve
Case Discussion
In this case, there is enhancement of the anterior nerve roots of the cauda equina. This can be seen in Guillain-Barré syndrome. However, with the T2 hyperintensity of the anterior horn cell and accompanying enhancement, this diagnosis does not fit.
Instead, think of polio virus infection and enterovirus 71 infection, the latter of which was confirmed on PCR. In 2017, there was an outbreak of enterovirus D68 infection. This predominantly affected the upper limbs with associated brainstem signal abnormality.