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A 69-year-old woman developed progressive distal paraesthesia in her hands and feet over 6 months, evolving to gait imbalance, spasticity and loss of independent walking. On examination, she had brisk tendon reflexes, bilaterally extensor plantar responses, impaired proprioception and a positive Romberg sign. MR scan of the spinal cord showed a longitudinally extensive T2/STIR hyperintensity in the dorsal columns of the cervical and upper thoracic cord, without contrast enhancement ( figure 1).