A seemingly usual case of paraplegia with MRI diagnosis of meningioma: An unexpected course of events leading to inflammatory necrotizing myelopathy

Abstract

Necrotizing myelopathy is a rare but potentially devastating disease and an important cause of paralysis. Its diagnosis can be challenging inspite of availability of magnetic resonance imaging (MRI) and laboratory investigations. The differential diagnoses of this condition are tuberculosis, Foix–Alajouanine syndrome, transverse myelitis, and spinal tumors. The purpose of this case report was to document the pathological findings of this entity and highlight the misleading tendency of postoperative thick fibrous scar tissue, which may complicate the MRI picture of necrotizing myelopathy and it may masquerade as an intradural meningioma. The spinal cord biopsy is the only way to confirm the diagnosis in suspected cases based on the gradual subacute progression of clinical symptoms and MRI findings of rim-like rather than solid enhancement.