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Abstract Details

Mimicker of Neuroinflammatory Myelopathy
Autoimmune Neurology
P3 - Poster Session 3 (12:00 PM-1:00 PM)
069
To report a case of spinal cord infarct with diagnostic overlap with inflammatory etiology.
Background: A 66-year-old female presented with acute onset weakness and numbness of both legs. She was found on exam to have flaccid weakness in both legs with a sensory level to all modalities at T10 dermatome. Patellar and Achilles reflexes were absent and Babinski mute bilaterally
NA

Results: MRI thoracic spine revealed long segment expansile cord T2 hyperintensity from T8 to L1 levels with thin gadolinium contrast enhancement and restricted diffusivity. CSF analysis showed WBC 91/mm³ (neutrophils 92%), glucose 70 mg/dL, protein 76 mg/dL, negative culture. Infectious, rheumatologic, hematologic, and neuroinflammatory workup (including anti-AQP4 and anti-MOG) were negative except for elevated glutamic acid decarboxylase 65 isoform antibody titers. Spinal angiography was normal.

She was treated with intravenous immunoglobulins and high-dose methylprednisolone for myelitis. However, she experienced minimal clinical improvement and was re-treated with plasma exchange a few weeks later, again with minimal clinical response. Follow-up spinal MRI of thoracic spine showed spinal cord atrophy with significant volume loss and myelomalacia, suggestive of sequela of cord infarct.
Conclusion: Non-inflammatory and inflammatory causes of myelopathy can have overlapping MRI and CSF findings. CSF pleocytosis and lesion enhancement, while typical for inflammatory cases, can also occur in non-inflammatory causes. The temporal profile of symptoms may be the most helpful clue in etiological determination. In our case, the hyperacute onset of symptoms favors vascular etiology, despite the long-segment expansile lesion with enhancement. Also vascular myelopathy may present without anterior-posterior gradient of sensory deficits (classic sparing of vibration/proprioception due to sparing of posterior dorsal column pathways) especially when involving thoracolumbar and lumbosacral zones.
Authors/Disclosures
Ahya S. Ali, MD (Westchester Medical Center)
PRESENTER 		Dr. Ali has nothing to disclose.
Yarden Bornovski, MD (Westchester Medical Center) Dr. Bornovski has nothing to disclose.
Carolin Dohle, MD Dr. Dohle has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion TPharmaceuticals. Dr. Dohle has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics.
Jon Rosenberg, MD Dr. Rosenberg has nothing to disclose.
Shamik Bhattacharyya, MD, FAAN (Brigham and Women's Hospital) Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NeuroLambda. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Bhattacharyya has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Bhattacharyya has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. Dr. Bhattacharyya has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Merck. The institution of Dr. Bhattacharyya has received research support from Alexion Pharmaceuticals. The institution of Dr. Bhattacharyya has received research support from National Institute of Health. The institution of Dr. Bhattacharyya has received research support from UCB. The institution of Dr. Bhattacharyya has received research support from Genentech. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care. Dr. Bhattacharyya has received publishing royalties from a publication relating to health care.
Chaitanya Medicherla, MD Dr. Medicherla has nothing to disclose.