Progressive peripheral neuropathy on a background of Waldenström's macroglobulinaemia.
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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.
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.