Clinical Neuroradiology

, Volume 27, Issue 4, pp 417–433 | Cite as

Magnetic Resonance Imaging and Clinical Features in Acute and Subacute Myelopathies

  • Stefan Weidauer
  • Marlies Wagner
  • Michael Nichtweiß
Review Article

Abstract

Differential diagnosis of acute and subacute transverse myelopathy includes inflammatory, infectious, vascular, metabolic and paraneoplastic etiologies. Information on the diagnostic approach to transverse myelopathy with regard to daily clinical practice is provided. The differentiation between five lesion patterns on magnetic resonance imaging (MRI) in myelitis may be helpful: (1) longitudinal extensive transverse myelitis, (2) short segment ovoid or peripherally located, (3) “polio-like”, (4) granulomatous and (5) segmental with rash. A correlation with these imaging features is supported if the clinical course and neurological symptoms are known. Although the mean interval from onset to nadir of symptoms in spinal cord infarction is 1 h, an overlap with a fulminant course of myelitis is possible, and impaired diffusion may also occur in acute inflammatory processes. As a result, laboratory testing, including aquaporin-4 antibodies and cerebrospinal fluid analysis, is crucial for the correct interpretation of imaging findings. Moreover, the discrimination of acute complete and acute partial transverse myelitis is advantageous in order to identify diverse entities, the latter often being a precursor to multiple sclerosis. Additional brain imaging is mandatory in suspected demyelinating, infectious, neoplastic and systemic autoimmune disease. A symmetrical lesion pattern restricted to individual tracts or dorsal columns indicates subacute combined degeneration of the spinal cord and, in addition to deficiency syndromes, a paraneoplastic etiology should be considered.

Keywords

Myelopathy Myelitis Magnetic resonance imaging Spinal cord infarct Spinal vascular disease 

Notes

Conflict of interest

S. Weidauer, M. Wagner and M. Nichtweiß declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Stefan Weidauer
    • 1
  • Marlies Wagner
    • 2
  • Michael Nichtweiß
    • 3
  1. 1.Department of NeurologySankt Katharinen Hospital, Teaching Hospital of the Goethe University, FrankfurtFrankfurt/MainGermany
  2. 2.Institute of NeuroradiologyGoethe UniversityFrankfurtGermany
  3. 3.WismarGermany

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