Myelopathy



Myelopathy


Kevin R. Moore, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Infection/Inflammation



    • Abscess, Epidural


    • Abscess, Subdural


    • Multiple Sclerosis, Spinal Cord


  • Neoplasm and Cyst



    • Syringomyelia


    • Astrocytoma, Spinal Cord


    • Ependymoma, Cellular, Spinal Cord


    • Hemangioblastoma, Spinal Cord


  • Trauma



    • Central Spinal Cord Syndrome


    • Contusion-Hematoma, Spinal Cord


    • Hematoma, Epidural-Subdural


    • Hematoma, Subdural


    • Syrinx, Post-Traumatic


  • Degenerative



    • Degenerative Disc Disease


    • Stenosis, Acquired Spinal, Cervical


    • Kyphosis


    • Spondylolisthesis


    • OPLL


    • Ossification Ligamentum Flavum


  • Intervertebral Disc Herniation



    • Intervertebral Disc Herniation, Cervical


    • Intervertebral Disc Herniation, Thoracic


    • Intervertebral Disc Herniation, Traumatic


Less Common



  • Congenital



    • Mucopolysaccharidoses


    • Stenosis, Congenital Spinal


    • Scoliosis and Kyphosis, Congenital


  • Infection/Inflammation



    • ADEM, Spinal Cord


    • Viral Myelitis


  • Neoplasm and Cyst



    • Osteochondroma


    • Pathologic Vertebral Fracture


    • Arachnoid Cyst


  • Vascular



    • Infarction, Spinal Cord


    • Type I DAVF


    • Type IV AVF


Rare but Important



  • Congenital



    • Spondyloepiphyseal Dysplasia


    • Dermoid and Epidermoid Tumors


    • Osteogenesis Imperfecta


  • Trauma



    • Spinal Cord Herniation


  • Neoplasm and Cyst



    • Neurenteric Cyst


    • Metastases, Spinal Cord


  • Vascular



    • Cavernous Malformation, Spinal Cord


    • Type II AVM


    • Type III AVM


  • Infection/Inflammation



    • Abscess/Myelitis, Spinal Cord


    • Acute Transverse Myelitis, Idiopathic


    • Secondary Acute Transverse Myelitis


    • Vitamin B12 Deficiency, Spinal Cord


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Myriad etiologies requires evaluation of pertinent clinical and laboratory information to narrow differential list


Helpful Clues for Common Diagnoses



  • Infection/Inflammation



    • Epidural and subdural abscess ⇒ rim-enhancing extramedullary pus ± cord signal or compression


  • Neoplasm and Cyst



    • Syringomyelia ⇒ expanded spinal cord + central dilated, beaded, or sacculated cystic cavity


    • Neoplastic syrinx ⇒ look for nodularity or enhancement


  • Trauma



    • Central spinal cord syndrome ⇒ arms > legs + bladder dysfunction, variable sensory loss, high T2 cord signal


  • Degenerative



    • OPLL, OLF ⇒ look for ligamentous ossification with narrowing of central spinal canal


  • Intervertebral Disc Herniation



    • Use conventional diagnostic criteria


Helpful Clues for Less Common Diagnoses



  • Congenital



    • Mucopolysaccharidoses ⇒ ± dens hypoplasia, CVJ stenosis, thickened dura at foramen magnum, platyspondyly, anterior beaking, thoracolumbar gibbus deformity


    • Congenital spinal stenosis ⇒ reduced AP canal diameter secondary to short, squat pedicles and laterally directed laminae


  • Infection/Inflammation




    • ADEM, spinal cord ⇒ multifocal lesions (MS mimic) with minimal mass effect, vasogenic edema


    • Viral myelitis ⇒ swollen, edematous cord with segmental contiguous T2 signal abnormality


  • Neoplasm and Cyst



    • Osteochondroma ⇒ sessile or pedunculated osseous “cauliflower” lesion, marrow contiguous with parent vertebra


    • Arachnoid cyst ⇒ nonenhancing extramedullary loculated CSF intensity collection displacing cord or nerve roots


  • Vascular



    • Spinal cord infarction ⇒ central T2 hyperintensity more common than wedge-shaped injury in anterior 2/3 spinal cord


Helpful Clues for Rare Diagnoses

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Myelopathy

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