Here, we present a case of cervical spondylotic myelopathy (CSM) with clinical, radiographic, and laboratory features suggestive of Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease (MOGAD).

MOGAD and CSM represent distinct neurological disorders, yet they often present with similar clinical features and radiographic findings, leading to potential diagnostic challenges. MOGAD, an autoimmune condition, can lead to myelopathy through myelitis, whereas spondylosis primarily causes myelopathy through compression of the spinal cord.

Not applicable

A 41-year-old male, with a history of lower back trauma, presented for evaluation for paraesthesias, weakness, and balance issues. An MRI of the cervical spine revealed a longitudinally extensive T2 hyperintense lesion spanning from C4 to C7, accompanied by patchy gadolinium enhancement specifically at the C5-C6 level. Lumbar puncture results showed no oligoclonal bands, but serum testing revealed a positive MOG antibody (1:40), aligning with MOGAD criteria. Treatment commenced with Intravenous Methylprednisolone followed by a tapering course of oral steroids, transitioning to mycophenolate. Despite treatment, the patient's symptoms persisted, prompting a reevaluation a year later. Repeat imaging demonstrated worsening cervical spinal stenosis, with mild interval resolution of edema and decreased enhancement. Consequently, the patient underwent spinal decompression and fusion. Subsequent MRI scans indicated resolution of contrast enhancement, suggesting a positive response to the surgical intervention.

Prior to diagnosing MOGAD as the cause of transverse myelitis, it's imperative to meticulously explore potential mimicking conditions, like spondylotic myelopathy. This becomes particularly crucial if there are signs of severe stenosis at the relevant spinal level. Spondylotic myelopathy may not only exhibit T2 hyperintensity but also display contrast enhancement, thus closely resembling transverse myelitis. Consequently, conducting a thorough assessment that encompasses the evaluation of spondylotic myelopathy features is indispensable for achieving an accurate diagnosis and ensuring the appropriate management of MOGAD.