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This was a 21-year-old who had an antecedent infection

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approximately six weeks prior to presenting

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with a brachial plexopathy.

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The MRI of the brain was performed as well as the

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cervical spine. The brain was unremarkable.

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When we look at the cervical spine

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on T2-weighted imaging,

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we see enlargement of the nerve roots coming out of the

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neuroforamina and extending into the brachial plexus.

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Let's do a quick reminder about the

0:30

anatomy of the brachial plexus.

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The brachial plexus is derived from the

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C5 through T1 nerve roots.

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And where we look for the brachial plexus, is behind

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the anterior scaling muscle, so posterior to it,

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but in front of the middle scaling,

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posterior scaling muscle complex.

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So it runs in that area between the two muscle groups.

0:54

And you can see that as bright signal intensity here on

0:58

the T2-weigghted scan coming from the neuroforamina.

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Now, in this case,

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the neuroforamina also appears to be enlarged bilaterally.

1:07

Again, brachial plexus coming through here,

1:10

and then it's going to run in close approximation to

1:12

the subclavian artery. Now, as we look at this,

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we would say that this is a process which is extradural,

1:20

that is, outside the thecal sac.

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However, on the post contrast scans,

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we see that in point of fact,

1:26

these nerve roots are showing abnormal contrast

1:29

enhancement with the anterior and posterior

1:32

rootlets coming out of the spinal cord.

1:35

In the neuroforamina,

1:37

the nerve roots are also showing contrast enhancement

1:40

as they extend from there into the brachial plexus.

1:44

So this is indeed an intradural extra medullary, as well

1:49

as an extradural process associated with enlargement of

1:52

the nerve roots. In this case, an example of CIDP.

1:58

CIDP may or may not show contrast enhancement of the nerve roots,

2:03

but it does show enlargement,

2:05

as you can see in the neuroforamina.

2:08

If we were to look on a parasagittal

2:10

image in the cervical spine,

2:12

you would be able to see this as well manifesting as

2:16

enlarged neuroforamina with nerve roots coming out

2:19

and the enhancement intradural extramedullary.