The challenge of acute non-compressive transverse myelopathies

Ambar Chakravarty

doi:10.3389/fneur.2010.00006

Abstract

The challenge of acute non-compressive transverse myelopathies

Highlights

The first question, when faced with a clinically obvious transverse myelopathy, is whether it is really a ‘new’ ‘acute’ onset disease or an ‘acute’ exacerbation of a preexisting unsuspected or unknown compressive or non-compressive myelopathic problem or perhaps a super addition of an acute non-compressive pathology on top of a mild pre-existing compressive problem
It must be stressed that spinal MRI must involve the entire spine with contrast and not limited only to the clinically suggestive level, to exclude unsuspected compressive pathology elsewhere and to gauge the full length of the detected spinal lesion and exclude multiplicity of similar lesions elsewhere in the spinal cord
The talk of the day is the discovery of the Aquaporin4 antibody (NMO-IgG), a hallmark of the neuromyelitis optica (NMO) spectrum disorders with long segment spinal cord signal changes with or without optic nerve involvement

Summary

Introduction

The first question, when faced with a clinically obvious transverse myelopathy, is whether it is really a ‘new’ ‘acute’ onset disease or an ‘acute’ exacerbation of a preexisting unsuspected or unknown compressive or non-compressive myelopathic problem or perhaps a super addition of an acute non-compressive pathology on top of a mild pre-existing compressive problem. It must be stressed that spinal MRI must involve the entire spine with contrast and not limited only to the clinically suggestive level, to exclude unsuspected compressive pathology elsewhere and to gauge the full length of the detected spinal lesion and exclude multiplicity of similar lesions elsewhere in the spinal cord. Even after careful radiological study, it may be sometimes difficult to differentiate inflammatory lesions from intramedullary tumors, subtle extramedullary spinal cord compression with marked signal changes in the spinal cord at the same level or even extending above and below the level including hematoma and/or ischemic events.

Results

Conclusion