OR Discussion of Procedures by Variant Variant 1: Acute onset myelopathy. Initial imaging. The body regions covered in this clinical scenario are cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination as guided by physical examination findings, patient history, and other available information, including prior imaging. Acute myelopathy can be subdivided into noninflammatory and inflammatory causes. Noninflammatory conditions include extrinsic compression of the spinal cord, vascular pathologies, and trauma. Inflammatory conditions include demyelinating diseases (ie, multiple sclerosis), systemic inflammatory diseases, and infection. Although infrequent, spinal cord ischemia can result in acute onset myelopathy and in adults is most commonly the result of atheromatous disease or as a complication of aortic surgery [3]. Other pathologies that may predispose patients to developing spinal cord ischemia include systemic hypotension, thoracoabdominal aneurysms or dissection, sickle cell disease, and spinal arteriovenous malformations (AVMs) [27,28]. Very rarely, patients may develop hematomyelia and subsequently acute myelopathy because of an intrameduallary AVM or spinal artery aneurysm rupture [29,30]. Acute ischemic myelopathy can also develop in the setting of fibrocartilaginous embolic disease [31]. Depending on the level(s) of the spinal cord involved, patients will typically develop acute paraparesis or quadriparesis. Inflammatory conditions that can result in acute myelopathy include demyelinating diseases such as multiple sclerosis (MS), neuromyelitis optica (NMO), and acute disseminated encephalomyelitis (ADEM); systemic inflammatory conditions such as systemic lupus erythematous, Sjogren syndrome, mixed connective tissue disorder, Behcet disease, and sarcoidosis; and infectious diseases [8]. MRI Spine MRI is useful for evaluation of the spinal cord when investigating the etiology of acute myelopathy [32].
Myelopathy PCAs. OR Discussion of Procedures by Variant Variant 1: Acute onset myelopathy. Initial imaging. The body regions covered in this clinical scenario are cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination as guided by physical examination findings, patient history, and other available information, including prior imaging. Acute myelopathy can be subdivided into noninflammatory and inflammatory causes. Noninflammatory conditions include extrinsic compression of the spinal cord, vascular pathologies, and trauma. Inflammatory conditions include demyelinating diseases (ie, multiple sclerosis), systemic inflammatory diseases, and infection. Although infrequent, spinal cord ischemia can result in acute onset myelopathy and in adults is most commonly the result of atheromatous disease or as a complication of aortic surgery [3]. Other pathologies that may predispose patients to developing spinal cord ischemia include systemic hypotension, thoracoabdominal aneurysms or dissection, sickle cell disease, and spinal arteriovenous malformations (AVMs) [27,28]. Very rarely, patients may develop hematomyelia and subsequently acute myelopathy because of an intrameduallary AVM or spinal artery aneurysm rupture [29,30]. Acute ischemic myelopathy can also develop in the setting of fibrocartilaginous embolic disease [31]. Depending on the level(s) of the spinal cord involved, patients will typically develop acute paraparesis or quadriparesis. Inflammatory conditions that can result in acute myelopathy include demyelinating diseases such as multiple sclerosis (MS), neuromyelitis optica (NMO), and acute disseminated encephalomyelitis (ADEM); systemic inflammatory conditions such as systemic lupus erythematous, Sjogren syndrome, mixed connective tissue disorder, Behcet disease, and sarcoidosis; and infectious diseases [8]. MRI Spine MRI is useful for evaluation of the spinal cord when investigating the etiology of acute myelopathy [32].