Nontraumatic Myelopathy Research Articles

Cocaine-related cervical spinal cord infarction: a\xa0case report and review of the\xa0literature

Study designCase report.ObjectivesTo report a clinical case of spinal cord infarction due to cocaine use.SettingSpinal Center, IRCCS Fondazione S. Lucia, Rome (Italy).Case presentationTwo days after recreational use of cocaine, a 27-year-old Caucasic man was admitted to the emergency department for acute cervical pain, weakness in all four limbs, and urinary retention. A cervical spinal magnetic resonance imaging scan, performed after 2 days, showed a “pencil-like” lesion extending from C4 to T1 metamer, compatible with acute ischemia in the anterior spinal artery territory. Other causes of vascular disorders, as well as inflammatory and infectious disorders were ruled out. At admission in our department, the patient had an incomplete tetraplegia at level C6, an indwelling catheter, and was unable to stand and walk. After 3 months of rehabilitation, he had an AIS score D tetraplegia at level C7, was able to stand and walk using parallel bars, and indwelling catheter was replaced by intermittent catheterization.Discussion and conclusionsThe etiology of medullary infarction may remain unexplained in nearly 30–40% of cases. Even if rare, cocaine-induced ischemic myelopathy should be considered and ruled out in the differential diagnosis of any acute nontraumatic myelopathy, especially in young patients.

Acute Myelopathy in Childhood.

Acute myelopathy presenting in childhood can be clinically classified based on the location of injury (with resulting spinal syndrome) or the cause (broadly traumatic or non-traumatic). Types of nontraumatic myelopathy include ischaemic, infectious, inflammatory, nutritional, and metabolic causes, some of which may be part of a systemic illness such as systemic lupus erythematosus or a demyelinating disease such as multiple sclerosis. Nonaccidental injury is an important consideration in cases of traumatic myelopathy, which may often be associated with other injuries. Assessment should include neuroimaging of the brain and spinal cord, with further investigations targeted based on the most likely differential diagnoses; for example, a child with suspected demyelinating disease may require specialist cerebrospinal fluid and serological testing. Management also will differ based on the cause of the myelopathy, with several of these treatments more efficacious with earlier initiation, necessitating prompt recognition, diagnosis, and treatment of children presenting with symptoms of a myelopathy. Important components of holistic care may include physiotherapy and occupational therapy, with multidisciplinary team involvement as required (for example psychological support or specialist bowel and bladder teams).

CLINICAL PROFILE AND ETIOLOGICAL EVALUATION OF NON-TRAUMATIC MYELOPATHIES USING MAGNETIC RESONANCE IMAGING

Objective: The present study was conducted with an objective to identify the etiology of non-traumatic myelopathies of both compressive and non-compressive types with the aid of magnetic resonance imaging (MRI).
 Methods: This retrospective observational cross-sectional study was conducted on 100 patients with a clinical diagnosis of non-traumatic myelopathy belonging to the age group of 15–75 years from August 2018 to July 2020 in the Departments of General Medicine and Radiodiagnosis of MKCG Medical College and Hospital, Berhampur, Odisha. Detailed history, clinical evaluation, laboratory investigations, and findings of MRI spine and brain were compiled. Results were analyzed using descriptive statistics.
 Results: Among 100 patients of non-traumatic myelopathy, 65 patients presented with compressive myelopathy and 35 patients with non-compressive myelopathy where 56 patients presented with paraparesis and 44 with quadriparesis. Pott’s spine (n=25, 38.46%) and acute transverse myelitis (ATM) (n=24, 68.57%) were the most common etiologies found in compressive and non-compressive groups, respectively.
 Conclusion: Pott’s Spine, spondylotic myelopathy, and ATM were the most common etiologies of non-traumatic myelopathy. MRI has proven to be the ultimate imaging modality for their etiological evaluation.

Myelopathies in patients older than 50: not to miss inflammatory etiologies.

Background: Inflammatory myelopathies are primarily associated with younger age, and there are few studies in the elderly. Longitudinally extensive spinal cord lesions (LECL) are common in inflammatory myelopathies, but when the first event occurs in older age may have a broader differential diagnosis.Objectives: To identify all non-traumatic myelopathies' etiologies in patients older than 50 years in a tertiary care hospital and to evaluate characteristics that differentiate inflammatory from non-inflammatory etiologies, focusing on the late-onset (≥50 years old) longitudinally extensive spinal cord lesions (LO-LECL) group.Methods: Retrospective study of patients admitted between 2008 to 2019. Demographic, clinical, laboratory, and magnetic resonance imaging (MRI) data of all patients were analyzed to identify predictors that could more easily identify inflammatory from non-inflammatory etiologies and further identify the etiologies of LO-LECL.Results: One hundred and three patients 50 years or older diagnosed with non-traumatic myelopathy were included, despite the lesion extension. Five were vascular (5%), 10 spondylotic (10%), 16 other etiologies (16%), 22 inflammatory (21%) and 50 neoplastic myelopathies (49%). Among 23 LO-LECL, 3 were vascular (13%), 4 neoplastic (17%), 7 other etiologies (30%) and 9 inflammatory (39%). The inflammatory LO-LECL had the median time to nadir significantly different from the neoplastic and the other etiologies groups and had the median EDSS at last visit (3.5) significantly lower than the non-inflammatory LO-LECL (7.0-7.5).Conclusions: Inflammatory etiologies are not to be disregarded in older adults with non-traumatic myelopathies. The symptoms' temporal profile is critical to differentiate inflammatory LO-LECL from other etiologies and it has better functional recovery after adequate treatment.

Clinical-radiological approach to nontraumatic myelopathy

Diseases of the spinal cord often have devastating consequences and imaging studies are indispensable for their diagnosis. The fundamental imaging technique to evaluate these diseases is magnetic resonance imaging of the spine. The diagnostic approach must be based on the clinical context, the time elapsed since the onset of symptoms and signs, and the imaging findings; for this reason, it sometimes necessary to broaden the study to include the brain. The first step in the diagnostic algorithm is to rule out spinal cord compression before evaluating other causes of myelopathy, which sometimes has multiple causes. This paper includes a broad review of the different diseases that can cause myelopathy, their imaging manifestations, their differential diagnoses, and diagnostic algorithms. Using an appropriate radiological approach will result in better management and prognosis of these patients.

Nontraumatic Myelopathy in Malawi: A Prospective Study in an Area with High HIV Prevalence.

Nontraumatic myelopathy causes severe morbidity and is not uncommon in Africa. Clinically, patients often present with paraplegia, and extrinsic cord compression and transverse myelitis are most common causes. Data on exact pathogenesis are scanty because of limitations in diagnostic methods. In Queen Elizabeth Central Hospital, Blantyre, Malawi, we recorded consecutive patients presenting with nontraumatic paraplegia for maximally 6 months between January and July 2010 and from March to December 2011. The diagnostic workup included imaging and examining blood, stool, urine, sputum, and cerebrospinal fluid (CSF) samples for infection. After discharge, additional diagnostic tests, including screening for virus infections, borreliosis, syphilis, and schistosomiasis, were carried out in the Netherlands. The clinical diagnosis was, thus, revised in retrospect with a more accurate final differential diagnosis. Of 58 patients included, the mean age was 41 years (range, 12-83 years) and the median time between onset and presentation was 18 days (range, 0-121 days), and of 55 patients tested, 23 (42%) were HIV positive. Spinal tuberculosis (n = 24, 41%), tumors (n = 16, 28%), and transverse myelitis (n = 6, 10%) were most common; in six cases (10%), no diagnosis could be made. The additional tests yielded evidence for CSF infection with Schistosoma, Treponema pallidum, Epstein-Barr virus (EBV), HHV-6, HIV, as well as a novel cyclovirus. The diagnosis of the cause of paraplegia is complex and requires access to an magnetic resonance imaging (MRI) scan and other diagnostic (molecular) tools to demonstrate infection. The major challenge is to confirm the role of detected pathogens in the pathophysiology and to design an effective and affordable diagnostic approach.

Evaluation of non-traumatic myelopathy using magnetic resonance imaging

Background: Prompt and concise diagnosis of etiologic agent behind Non-Traumatic Myelopathy (NTM) and localization of the site of lesion are essential for prediction of neurological and functional outcomes. Magnetic Resonance Imaging (MRI) plays a key role in evaluation of myelopathy. Objectives: The objective of the present study was to characterize the spinal cord lesions in Non-traumatic Myelopathy and to evaluate the etiological factors leading to NTM. Materials and Methods: A hospital based cross-sectional study was done from November 2017 to May 2019 in a tertiary care centre of South India, where 85 patients with clinical suspicion of NTM were evaluated with MRI of spine. The MRI data collected was analyzed and described. Results: Out of 85 patients in our study group, 44 (51.8%) were males and 41 (48.2%) were females, without any significant gender predilection. The age group ranged from 5 to 83 years, with majority of patients in the 7th decade (25.9%). Degenerative myelopathy was the most common etiology accounting for 57.6% of the patients, followed by infective (28.2%), primary neoplastic (9.4%), congenital (1.1%), demyelinating (1.1%), metastatic (1.1%) and nutritional (1.1%) etiologies. Conclusion: MRI characteristics of the most common lesions were sufficiently distinct to allow them to be differentiated from each other and from most other entities. Other characteristics such as extradural versus intradural, intramedullary versus extramedullary, nature of enhancement on Post Gadolinium study, the presence of epidural, prevertebral and paravertebral involvement permit further differentiation among the various other abnormalities. MRI is a very sensitive, specific, non-invasive radiation-free modality for evaluation of NTM.

Hepatocellular carcinoma with initial presentation as metastatic spinal cord compression

Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver. The burden of HCC is highest in the sub-Saharan Africa, South-East Asia and China. The recognized risk factors for HCC are chronic hepatitis B virus and hepatitis C virus infection, dietary aflatoxin, and alcoholic liver disease among others. HCC typically presents with symptoms related to the primary tumor; abdominal pain, weight loss, and abdominal swelling. Extrahepatic spread is present in up to 15% of patients with HCC at the time of diagnosis and may be the primary presentation. The most common site of extrahepatic metastasis by several authors is the lungs. Bone metastases in HCC are not as rare as previously reported and the most frequent site is the spine. Bone metastasis is mainly osteolytic and may result in pathologic fractures, hypercalcemia, and reduced quality of life. Spinal metastasis of HCC is recognized as a terminal stage of the disease and considerably worsens the prognosis. Presented is a case of a 35-year old man who came to the hospital primarily with metastatic spinal cord compression syndrome with paraplegia and was found to have advanced HCC. He succumbed to the disease within one month of presentation. While Pott's disease of the spine and metastatic prostatic tumor are the most common causes of nontraumatic myelopathy in sub-Saharan Africa, HCC should always be considered in the differential diagnosis of any patient with vertebral disease of uncertain origin.

The Description of Urodynamic Study for Bladder Dysfunction in Compressive Myelo- or Radiculo-pathy: A Prospective Study in an Institutional Setup.

Purpose:To study the significance of filling cystometry with pressure flow studies and bladder electromyography (EMG) in assessment and management of neurogenic bladder with myelopathies and evaluated neurological recovery in the follow-up period.Methods:The study was a 3-year prospective urodynamic study in 63 patients, with traumatic and nontraumatic myelopathy. Bladder management was advised based on the cystometric findings. Neurological recovery and mode of bladder management were evaluated during follow-up after a minimum of 6 months.Results:Mean age was 44.6 years (range 10–80 years). Thoracolumbar area was most commonly involved. Cystometry revealed overactive detrusor in 46 patients, (17 had detrusor sphincter dyssynergia [DSD], 29 without DSD) and areflexic/underactive detrusor in 9 patients. Postvoid residual (>15% of voided urine) was significant in 27 patients. Neurological recovery was seen in 60.3%, whereas 22.2% showed no improvement (partial improvement in 4.8%) and 12.6% had normal bladder function both initially and at follow-up. Correlation between neurological recovery and bladder management was found to be insignificant (P > 0.05) using spearman's correlation coefficient.Conclusion:Filling cystometry with pressure flow studies and EMG study is valuable for the assessment and management of neurogenic bladder in patients with myelopathy. In neurogenic bladder management and follow-up, pressure flow studies help to prevent complications and upper urinary tract complications.

MRI features in the non-traumatic spinal cord injury patients presenting at the Korle Bu Teaching Hospital, Accra.

Neurological limb deficit due to non-traumatic myelopathy is a disabling and distressing neurological condition. In recent time Magnetic Resonance Imaging (MRI) has proven to be the ultimate imaging modality for evaluating pathologies of the spinal cord. To describe the Magnetic Resonance Imaging (MRI) features of patients with Non-Traumatic Spinal Cord Injury evaluated at the Korle Bu Teaching Hospital. A descriptive cross-sectional study was carried out at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. Out of a total of 141 MRI's evaluated 60.3% were males and 39.7% female. The majority of the respondents 85.1% had paraparesis/paraplegia, 13.5% had quadriparesis/quadriplegia, 1.4% had weakness in one upper limb and both lower limbs. The commonest MRI features of NTSCI recorded was due to degenerative disease of the spine 75.9%, spinal metastases 5.7%, Pott's /pyogenic spondylitis 3.5%, demyelinating disease 2.8% and primary spinal tumours 2.8%. The commonest MRI findings in the study population were due to degenerative disease of the spine, followed by spinal metastases and infective spondylitis. Not declared.

Magnetic Resonance Imaging-Based Evaluation of the Etiology of Non-Traumatic Myelopathies in Bangladesh: A Hospital-based Observational Cross-sectional Study from Two Tertiary Care Centers of Dhaka

Background: Non-traumatic myelopathies has several etiologies.Objectives: The aim of the study was to see the etiology of non-traumatic myelopathy based on magnetic resonance imaging (MRI) changes in the context of Bangladesh.Methodology: Patients clinically diagnosed as non-traumatic myelopathy in the department of neurology of Sir Salimullah Medical College and Hospital (SSMCH), and in the inpatient wards of the National Institute of Neurosciences (NINS), considering the inclusion and exclusion criteria were enrolled as the study population from May 2014 to December 2015. Age, gender, clinical presentations and type of lesion based on MRI changes were collected. All the data were analyzed statistically.Results: Total 100 cases satisfied the inclusion and exclusion criteria in this study. Among them, there were 62 males and 38 females with a male to female ratio of 1.63:1. The mean age was found to be (mean ± SD) 45.80 ±15.28 with age ranges from 15 to 74 years. The highest number of patients (26.0%) was in the age group 51-60 years, followed by 24% patients in the age group 31-40 years. Based on MRI scan, most common etiologies that commonly diagnosed are cervical spondylotic myelopathy (31%), transverse myelitis (26%), primary spinal tumour (13%), spinal tuberculosis(12%), spinal metastatic disease (12%), and unclassified (6%). MRI scan also detect the common sites of involvements of these causes.Conclusion: In this study cervical spondylotic myelopathy, transverse myelitis, and spinal tuberculosis are the most common cause of non-traumatic myelopathy in the context of Bangladesh.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 87-91

Non-traumatic myelopathy associated with prolonged hyperextension during swimming: an unusual variation of Surfer's Myelopathy.

Surfer's myelopathy (SM) is a rare cause on non-traumatic acute myelopathy. This has classically been described in novice surfers however has been reported in other scenarios. We present a case of non-traumatic paraparesis associated with prolonged cervical hyperextension during swimming with imaging characteristics consistent with an unusual variation of SM in a swimmer. SM and its variants should be considered in the differential diagnosis of any patient presenting with an anterior spinal cord syndrome with a history of either sustained or repeated spinal hyperextension.

A Systematic Review of Non-Traumatic Spinal Cord Injuries in Sub-Saharan Africa and a Proposed Diagnostic Algorithm for Resource-Limited Settings.

Non-traumatic myelopathy is common in Africa and there are geographic differences in etiology. Clinical management is challenging due to the broad differential diagnosis and the lack of diagnostics. The objective of this systematic review is to determine the most common etiologies of non-traumatic myelopathy in sub-Saharan Africa to inform a regionally appropriate diagnostic algorithm. We conducted a systemic review searching Medline and Embase databases using the following search terms: "Non traumatic spinal cord injury" or "myelopathy" with limitations to epidemiology or etiologies and Sub-Saharan Africa. We described the frequencies of the different etiologies and proposed a diagnostic algorithm based on the most common diagnoses. We identified 19 studies all performed at tertiary institutions; 15 were retrospective and 13 were published in the era of the HIV epidemic. Compressive bone lesions accounted for more than 48% of the cases; a majority were Pott's disease and metastatic disease. No diagnosis was identified in up to 30% of cases in most studies; in particular, definitive diagnoses of non-compressive lesions were rare and a majority were clinical diagnoses of transverse myelitis and HIV myelopathy. Age and HIV were major determinants of etiology. Compressive myelopathies represent a majority of non-traumatic myelopathies in sub-Saharan Africa, and most were due to Pott's disease. Non-compressive myelopathies have not been well defined and need further research in Africa. We recommend a standardized approach to management of non-traumatic myelopathy focused on identifying treatable conditions with tests widely available in low-resource settings.

Abstract WP217: Association Between Atrial Fibrillation and Spinal Cord Infarction

Introduction: Spinal cord infarction (SCI) is a rare ischemic event comprising 1% of all strokes. In many cases of SCI, the cause remains undetermined. Case reports have suggested a relationship between cardiac embolism and SCI, but the association between the most common cause of cardiac embolism, atrial fibrillation (AF), and SCI has not been evaluated. Hypothesis: AF is associated with SCI. Methods: We performed a retrospective cohort study using inpatient and outpatient claims data from 2008-2014 on a 5% sample of Medicare beneficiaries. Our predictor variable was AF, ascertained by previously validated ICD-9-CM codes. The primary outcome was SCI, defined as ICD-9-CM diagnosis code 336.1 (vascular myelopathy) among patients who underwent spinal magnetic resonance imaging to rule out a compressive lesion and who did not have a concomitant diagnosis of degenerate joint disease, the most common cause of non-traumatic compressive myelopathy. In sensitivity analyses, we also excluded SCI cases accompanied by codes for traumatic spinal cord injury, spinal cord abscess, or spinal or aortic surgery. Cox proportional hazards analysis was used to assess the relationship between AF and SCI while adjusting for demographic characteristics and vascular risk factors. Results: Among 1,638,461 patients with a mean 3.9 years of follow-up, 423,856 had AF and 22 developed SCI. The annual incidence of SCI was 8.2 (95% confidence interval [CI], 4.4-15.4) per million in patients with AF compared to 2.3 (95% CI, 1.3-4.0) per million per year in those without AF. After adjustment for demographic characteristics and vascular risk factors, AF was associated with a higher risk of SCI (hazard ratio [HR], 4.8; 95% CI, 1.7-13.6). The association between AF and SCI persisted or grew stronger after excluding those with concomitant diagnoses of spinal cord injury, spinal abscess, and spinal or aortic surgery. Conclusions: In Medicare beneficiaries, AF was associated with increased risk of subsequent SCI. These results suggest the need for a thorough evaluation of potential underlying cardioembolic sources in patients with otherwise unexplained SCI.

The Risk of Non-Traumatic Myelopathy in Time Trial (TT) or Downhill (DH) Bike Position

The Risk of Non-Traumatic Myelopathy in Time Trial (TT) or Downhill (DH) Bike Position

Clinical features and inpatient rehabilitation outcomes of infection-related myelopathy.

This was a retrospective cohort study. The objectives of this study were to determine clinical features of infection-related myelopathy (IRM) and functional outcomes compared with other nontraumatic and traumatic myelopathies. US academic inpatient rehabilitation unit. This was a 16-year retrospective review of patients with myelopathy discharged from inpatient rehabilitation between 1 January 1995 and 31 December 2010. Patients comprised three injury groups: IRM, nontraumatic myelopathy (NTM) and traumatic spinal cord injury (TSCI). Information collected includes demographic characteristics, functional data, length of stay, injury completeness and discharge destination. Primary outcome measures were change in Functional Independence Measure (FIM) and daily FIM change. For IRM, data were collected regarding injury characteristics, risk factors, presenting symptoms, neurologic impairment level and treatment. Of the 1601 patients, 40 (2.5%) had IRM, 1105 (69.0%) had NTM and 456 (28.5%) had TSCI. IRM mean (s.d.) age was 58.6 (15.7) years (male gender, 72.5%). The majority in each group had incomplete injuries. IRM had longer lengths of stay (P<0.001), lower admission (P=0.001) and discharge (P=0.005) FIM scores and lower FIM daily change (P=0.002) than NTM. Degree of functional improvement was similar in all groups, and most patients in each group were discharged home. Infectious pathogens were bacterial (80.0%, n=32), viral (7.5%, n=3), tuberculous (7.5%, n=3), parasitic (2.5%, n=1) and multiple types (2.5%, n=1). The most common bacterial cause (65.6%) was Staphylococcus aureus. Infectious etiologies comprise a small proportion of NTM but represent a unique entity with distinct recovery patterns and outcomes. These patients can achieve similar functional improvements as other NTM patients during inpatient rehabilitation, although over a longer period of time.

Clinical and epidemiological profiles of non-traumatic myelopathies.

Non-traumatic myelopathies represent a heterogeneous group of neurological conditions. Few studies report clinical and epidemiological profiles regarding the experience of referral services. Objective To describe clinical characteristics of a non-traumatic myelopathy cohort. Method Epidemiological, clinical, and radiological variables from 166 charts of patients assisted between 2001 and 2012 were compiled. Results The most prevalent diagnosis was subacute combined degeneration (11.4%), followed by cervical spondylotic myelopathy (9.6%), demyelinating disease (9%), tropical spastic paraparesis (8.4%) and hereditary spastic paraparesis (8.4%). Up to 20% of the patients presented non-traumatic myelopathy of undetermined etiology, despite the broad clinical, neuroimaging and laboratorial investigations. Conclusion Regardless an extensive evaluation, many patients with non-traumatic myelopathy of uncertain etiology. Compressive causes and nutritional deficiencies are important etiologies of non-traumatic myelopathies in our population.

Nontraumatic myelopathy at the University of Port Harcourt Teaching Hospital: Magnetic resonance imaging evaluation

Objective: The aim of the study is to evaluate the etiology of nontraumatic myelopathy on magnetic resonance imaging (MRI) with a view to highlight the most common causes. Materials and Methods: We retrospectively examined the images and reports of patients with nontraumatic spinal cord lesion who presented to the Radiology Department of University of Port Harcourt Teaching Hospital for MRI scan between 2007 and 2012. The following data were collected: age, gender, types of lesions, and location of lesions. Cases with incomplete information were eliminated and cases with conflicting image findings and reports were reviewed. Institutional ethics approval was not necessary for this retrospective study. The data were analyzed statistically using Statistical Package for the Social Sciences (SPSS) 14.0 window evaluation version. Results: Seventy-three patients satisfied the criteria for inclusion in the study. Of these patients, there were 21 females and 52 males giving a female-to-male ratio of 1:2.5. The mean age was 37 years (age range of 15-78 years). The age range of 51-60 years had the highest frequency of lesions, accounting for 29. 17%. Disc degenerative disease was found to rank the highest among the lesions seen on MRI, accounting for 46. 6%. Conclusion: MRI is useful in detecting and localizing the spinal cord lesion responsible for myelopathy. The finding in this study that the commonest cause of myelopathy is spondylosis has contributed to bringing into limelight the burden of degenerative spinal lesion in the environment and the need to provide adequate facilities for management of the condition.

Pediatric Surfer's Myelopathy

BackgroundWe present the case of the youngest known patient diagnosed with surfer's myelopathy. Surfer's myelopathy is a rare nontraumatic myelopathy. The most likely etiology, presumably, is arterial insufficiency related to spine hyperextension. Symptoms consist of back pain, urinary incontinence or retention, paraplegia, and sensory loss. Case ReportA 7-year-old girl presented with back pain, urinary retention, and lower extremity weakness after doing backbends during a cheerleading practice the day prior to presentation. Why Should an Emergency Medicine Physician Be Aware of This?With the trend of children becoming increasingly active in competitive sports at a younger age, surfer's myelopathy is a diagnosis that should be considered when the symptoms are present and the history consists of hyperextending the back. As in our case, a seemingly benign trauma can lead to the diagnosis of surfer's myelopathy.

Mielopatía espondilótica que simula una mielitis: claves diagnósticas mediante resonancia magnética

Spondylotic myelopathy is the commonest cause of nontraumatic myelopathy. Radiological features of spondylotic myelopathy can often overlap with inflammatory myelopathies which may lead to a delayed or incorrect diagnosis and therapy. A distinctive gadolinium enhancement pattern recently described may help to differentiate spondylotic from inflammatory myelopathy. Case 1: a 38-years-old man presented with a 2-year history of paresthesias in the upper extremities, and one year later cramps on the right limbs and numbness over right C5 and C6 dermatomes, related to movement of the neck. Case 2: a 44-year-old man presented with a 1-year history of progressive gait difficulties and sensory disturbance in the hands, and a recent onset of bladder dysfunction. In both cases, spinal cord MRI identified a longitudinal cervical T2-signal hyperintensity associated with a pancakelike transverse band of gadolinium enhancement just below the site of maximum spinal stenosis, and circumferential or hemicord enhancement on axial images. The radiological features of spondylotic myelopathy may resemble those of inflammatory origin. The recognition of a transverse pancakelike gadolinium enhancement immediately below the site of maximal compression as a typical radiological pattern of spondylotic myelopathy is important to reduce the risk of misdiagnosis and to help in the management of these patients.