Early postmyelographic cauda equina syndrome in an asymptomatic young acromegalic is presented. The patient was asymptomatic for more than 1 yr despite myelographic evidence of acquired spinal stenosis at the L2-L4 level. Radiographic and/or myelographic findings should be clinically correlated. It is postulated that, in acromegaly, the combined simultaneous bony apposition-remodeling resorption mechanism is involved in the spine as platyspondyly, hyperostosis of spinous processes and vertebral scalloping to counteract soft tissue hyperplasia within the spinal canal; entrapment myelopathy, cauda equina syndrome and/or radiculopathy are ascribed to a soft tissue edematous mechanism superimposed on congenital or degenerative spinal stenosis, traumatic or postoperative spondylolisthesis, postmyelographic and/or postoperative arachnoiditis and a traumatic swollen or protrused intervertebral disc.
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