Acute Autonomic and Sensory Neuropathy with Diagnostic Gadolinium-Enhanced MRI findings of the Posterior Spinal Nerve Roots: A Case Report.

Acute autonomic and sensory neuropathy (AASN) is a rare disorder characterized by severe autonomic and sensory dysfunction without motor involvement, often occurring after a febrile illness. A 47-year-old woman had recurrent syncope episodes four days after fever onset, followed by progressive deep sensory loss. On day 14 of hospitalization at the previous hospital, she was transferred to our institution. Magnetic resonance imaging revealed hyperintensity in the posterior columns of the cervical cord spanning three vertebral levels on T2-weighted images and diffuse enhancement of the posterior roots in the cervical and lumbar spinal cord on contrast-enhanced T1-weighted images. Sensory responses were absent in nerve conduction studies, whereas motor responses in both the upper and lower extremities were preserved. Two weeks after syncope became apparent, aggressive immunotherapy was administered; however, the outcome was poor. The early recognition of autonomic and sensory neuropathy, along with contrast-enhanced MRI of the spinal cord, may be useful for the diagnosis and management of AASN.