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A 46-year-old woman with type 1 neurofibromatosis (NF1) reported a history of mild chronic pain involving her back and limbs. She had multiple neurocutaneous stigmata of NF1 including neurofibromas (Figure, A). She exhibited myelopathic changes in her lower limbs, with increased tone and hyperreflexia noted bilaterally and symmetrically. MRI of her spine showed diffuse dural ectasia from C4–T3, causing severe scalloping of the posterior endplates (Figure, B).
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