MRI spinal cord
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Abnormal T2 hyperintensity involving most of the length of the cord has bilaterally symmetric appearance, with signal abnorrmality centred on the anterior horns. There was no pathological enhancement within the cord, and no abnormally enhancing nerve roots.
Minimal disc protrusions at a few levels do not result in spinal canal stenosis or cord compression. No abnormal vascular flow voids or areas of susceptibility artefact within the cord.
In the context of febrile/diarrhoeal illness, an infective or postinfectious aetiology was considered likely, and the combination of acute flaccid paralysis with anterior horn changes favours poliomyelitis-like syndrome.
The MRI findings were not consistent with the initial clinical diagnosis of Guillain-Barre syndrome, which is characterised by normal cord appearance, with variable nerve root enhancement.
Grey matter signal abnormality with anterior horn predominance can be seen in cord ischaemia, however this would usually have a more abrupt onset of neurological deficit.