Abstract
This study aims to investigate the clinical features and magnetic resonance imaging (MRI) findings in patients with spinal cord infarction (SCI) and neuromyelitis optica spectrum disorders (NMOSDs). Over a period of 16 years, we retrospectively analyzed 39 patients with SCI and 21 patients with NMOSD. The demographic features and clinical presentations of both diseases were carefully documented. Etiology-specific MRI features, such as the length and distribution of the lesions, the owl’s eyes sign and bright spotty lesions, were recorded and analyzed regarding their association with the clinical signs/symptoms. Patients with SCI were older than patients with NMOSD and had sudden onset of clinical symptoms with focal pain adjacent to the lesions. Concomitant spinal cord and vertebral body infarctions were frequently associated with aortic pathology (p = 0.04). In addition, artery dissection was highly associated with combined ASA and unilateral PSA infarctions and long segments of SCI (all p < 0.05). In contrast, patients with NMOSD had a relatively younger age of onset, female predominance and subacute progression of limbs weakness. As observed by MRI, the length and location of the lesions demonstrated significant differences between the two diseases (P < 0.01). The owl’s eyes sign showed more frequently in patients with SCI than NMOSD (p < 0.01). The predicted prognoses in SCI and NMOSD were significantly associated with initial motor function (muscle power), after adjustments for age and gender (p < 0.01 and p = 0.02, respectively). Along with patient demographic characteristics, lesion features on MRI can help clinicians differentiate acute noncompressive myelopathy due to SCI from that due to NMOSD, which may lead to immediate initiation of adequate therapeutic measures.
Highlights
Acute noncompressive myelopathy is a neurological emergency characterized by a rapid progression of sensorimotor deficits with or without sphincter disturbances
Our results showed that the initial total Medical Research Council (MRC) scores had a significant association with short-term outcomes at one month, after adjusting for age and gender, in patients with spinal cord infarction (SCI) and those with neuromyelitis optica spectrum disorders (NMOSDs) (p < 0.01 and p = 0.02, respectively)
We focused only on acute noncompressive myelopathies resulting from SCI or NMOSD; other aetiologies, such as vascular malformation, infection, autoimmune processes and spinal cord lesions related to myelin oligodendrocyte glycoprotein (MOG) antibodies, were not included[13,38]
Summary
Acute noncompressive myelopathy is a neurological emergency characterized by a rapid progression of sensorimotor deficits with or without sphincter disturbances. The diagnosis of acute noncompressive myelopathy presents a challenge to clinicians, as several possible etiologies, such as vasculature, demyelination and inflammation, need to be considered in the differential diagnoses[1,2,3]. Spinal cord infarction (SCI) could mimic neuromyelitis optica spectrum disorders (NMOSD) because of several overlaps in the clinical presentations and magnetic resonance imaging (MRI) findings[4,5]. To help clinicians gain a better awareness of both diseases, we performed a retrospective study to evaluate the detailed clinical history, spinal cord MRI features and cerebrospinal fluid (CSF) characteristics at our institution (a tertiary medical center) in a group of patients with SCI or NMOSD
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