In patients who have undergone spinal surgery, late complications (eg, adjacent level degenerative disease with spinal stenosis, recurrent disc herniation) can result in extrinsic compression of the spinal cord and are best evaluated using MRI without and with IV contrast [44]. Demyelinating diseases such as MS can present as subacute/chronic myelopathy. MS is the classic demyelinating disease and is characterized by lesions affecting the spinal cord (and brain) and clinical defects disseminated in space and time [61]. Spinal cord involvement is seen in 80% to 90% of patients with MS, most commonly affecting the cervical cord [62]. Patients with primary progressive MS tend to have more spinal cord involvement than Myelopathy patients with relapsing-remitting MS [12]. When myelopathy due to MS is suspected, MRI detection of spinal cord lesion(s) fulfills part of the 2016 MAGNIMS criteria [63]. Other demyelinating processes such as NMO and ADEM can present as chronic myelopathy less commonly. In patients with chronic or progressive myelopathy, MRI of the spinal cord can identify spinal cord lesions suggestive of demyelinating disease in addition to excluding alternative etiologies. Contrast-enhanced imaging is recommended for initial diagnostic evaluation [69,70]. Metabolic causes of chronic or progressive myelopathy result in changes in the spinal cord known as subacute combined degeneration and are best evaluated with MRI [11,83,84]. Chronic infections can have a similar appearance [12]. Radiation-induced myelopathy is a rare dose-dependent complication that anatomically localizes to a prior radiation port [85]. Autoimmune myelitis includes paraneoplastic myelopathy [86,87]. MRI without and with IV contrast is useful to evaluate the spinal cord in these instances. Vascular malformations can likewise present with chronic and slowly progressive myelopathy [88].
Myelopathy PCAs. In patients who have undergone spinal surgery, late complications (eg, adjacent level degenerative disease with spinal stenosis, recurrent disc herniation) can result in extrinsic compression of the spinal cord and are best evaluated using MRI without and with IV contrast [44]. Demyelinating diseases such as MS can present as subacute/chronic myelopathy. MS is the classic demyelinating disease and is characterized by lesions affecting the spinal cord (and brain) and clinical defects disseminated in space and time [61]. Spinal cord involvement is seen in 80% to 90% of patients with MS, most commonly affecting the cervical cord [62]. Patients with primary progressive MS tend to have more spinal cord involvement than Myelopathy patients with relapsing-remitting MS [12]. When myelopathy due to MS is suspected, MRI detection of spinal cord lesion(s) fulfills part of the 2016 MAGNIMS criteria [63]. Other demyelinating processes such as NMO and ADEM can present as chronic myelopathy less commonly. In patients with chronic or progressive myelopathy, MRI of the spinal cord can identify spinal cord lesions suggestive of demyelinating disease in addition to excluding alternative etiologies. Contrast-enhanced imaging is recommended for initial diagnostic evaluation [69,70]. Metabolic causes of chronic or progressive myelopathy result in changes in the spinal cord known as subacute combined degeneration and are best evaluated with MRI [11,83,84]. Chronic infections can have a similar appearance [12]. Radiation-induced myelopathy is a rare dose-dependent complication that anatomically localizes to a prior radiation port [85]. Autoimmune myelitis includes paraneoplastic myelopathy [86,87]. MRI without and with IV contrast is useful to evaluate the spinal cord in these instances. Vascular malformations can likewise present with chronic and slowly progressive myelopathy [88].