A single focus of multiple sclerosis in the cervical spinal cord mimicking a radiculopathy

A 46 year old man was first examined in January 1996 for an impairment in the fine movements of his right hand. His history showed an optic retrobulbar neuritis, four years before, with a residual decrease of visual acuity to 6/10 and a pale disc on the left. Neurological examination disclosed only a disturbed stereognosis on his right hand. Visual evoked potentials (EPs) were very abnormal in the left, normal in the right eye. Brainstem auditory EPs and somatosensory EPs were normal. Both MRI of the brain and of the cervical spinal cord failed to show any aspect suggesting plaques. Cervical MRI showed extreme degenerative changes at the C5-C6 and C6-C7 level with a C6-C7 bulging disc. A cross section at the C5-C6 level showed a posterior ostheophyte impressing the subarachnoid space but no areas of abnormal signal intensity within the spinal cord. Analysis of CSF showed a protein concentration …