A practical approach to the diagnosis of spinal cord lesions

Abstract

Every neurologist will be familiar with the patient with atypical spinal cord disease and the challenges of taking the diagnosis forward. This is predominantly because of the limited range of possible clinical and investigation findings making most individual features non-specific. The difficulty in obtaining a tissue diagnosis further contributes and patients are often treated empirically based on local prevalence and potential for reversibility. This article focuses on improving the diagnosis of adult non-traumatic, non-compressive spinal cord disorders. It is structured to start with the clinical presentation in order to be of practical use to the clinician. We aim, by combining the onset phenotype with the subsequent course, along with imaging and laboratory features, to improve the diagnostic process.

Comparison of Clinical Outcomes of Transverse Myelitis Among Adults With Myelin Oligodendrocyte Glycoprotein Antibody vs Aquaporin-4 Antibody Disease

“…The predilection for MOG-Ab disease to involve the conus has been suggested as an important differentiator between MOG-Ab disease and AQP4-Ab disease. 3,7,14,16,17 The prevalence of conus involvement in our study in patients with MOG-Ab disease was 39%, and although prior reports have varied from 4% 18 to 75%, 19 a 2019 study by Dubey et al 14 aligned with our findings. We also found that involvement of the conus was associated with long-term sphincter dysfunction, particularly the requirement for catheterization.…”

Acute extensive myelopathy after single heroin and cocaine exposure in a patient with toxicological evidence of long-term drug abstinence

“…Additional neuroimaging observations do not support this possibility: unlike our patient, MRI findings are usually normal within the first hours after onset in cases of spinal cord infarction and enhancement is often absent at this stage 12 13. Moreover, ischaemia does not usually produce lymphocytic pleocytosis, as seen in our case 13…”

Tuberculous Myelopathy Associated with Longitudinally Extensive Lesion: A Clinicoradiological Review of Reported Cases

“…The clinical manifestations of patients with myelitis can be dramatic, including paraparesis/tetraparesis, altered gait, and bladder, bowel, and/or sexual dysfunction, as well as sensory impairment. 23 These dramatic losses of bodily function make early and accurate diagnosis vital. In 2002 the Transverse Myelitis Consortium Working Group introduced spinal MRI and CSF protein analysis as methods for identifying spinal cord inflammation into their diagnostic criteria (in addition to the clinical manifestation) to aid early and accurate diagnostic confirmation.…”