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A35 year old man developed, over a one month period, lumbosacral radicular symptoms and prominent nocturnal lower back pain of pulsating–burning quality, together with proximal weakness and an ill defined difficulty in coordination of the lower limbs. General and neurological examination were normal, except for impaired vibratory sensation in the right leg, depressed left knee reflex, and bilateral dysesthesias with L3–L4 distribution. Despite the patient’s complaints, gait and strength were not impaired.
Haematochemical investigations, including autoantibody search, were negative. MRI revealed a diffuse intramedullary process, extending from C1 to the conus medullaris. CSF examination revealed mildly increased albumin (6.7 g/dL), IgG …