A 41-year-old man developed progressive bilateral hand weakness and spastic paraparesis. MRI demonstrated cord edema and "pancake-like" gadolinium enhancement (figure). Inflammatory/neoplastic causes were investigated and not found. He continued to deteriorate despite empiric corticosteroid treatment. One year later, cervical decompression stabilized his clinical condition but intramedullary T2 signal worsened. Persistent enhancement raised concern about alternative diagnoses.
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