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Acute Transverse Myelopathy


KEY FACTS

Terminology

  • Noncompressive myelopathy

  • Acute transverse myelopathy (ATM) is broad generic term encompassing heterogeneous group of disorders causing cord dysfunction

    • Etiologies include inflammatory causes (ATM) + vascular disease + radiation + paraneoplastic + idiopathic (unknown)

    • ATM is more specific term for cord dysfunction that is inflammatory in etiology

      • –

        Inflammation defined by cerebrospinal fluid findings and MR enhancement

Imaging

  • Hyperintense lesion on T2WI with mild cord expansion ± enhancement

  • Longitudinally extensive (3+ segments) = neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), viral infection

Top Differential Diagnoses

  • Inflammatory etiologies

    • Acquired demyelinating

      • –

        Multiple sclerosis

      • –

        NMO

      • –

        ADEM

    • Parainfectious

    • Systemic autoimmune

    • Paraneoplastic (antineuronal immune disorder associated with cancer)

  • Noninflammatory mimics

    • Radiation

    • Metabolic

    • Tumor and cysts

    • Vascular

      • –

        Cord infarction

      • –

        Dural fistula (type I arteriovenous fistula)

  • Idiopathic ATM

Sagittal T2WI MR shows longitudinally extensive T2 hyperintensity throughout the cervical cord
and lower medulla
. Differential diagnoses include neuromyelitis optica, acute disseminated encephalomyelitis, and parainfectious and systemic autoimmune disorders.

Sagittal T1 C+ MR in the same patient does not demonstrate significant postgadolinium enhancement. The presence of longitudinally extensive abnormality in this patient suggests that MS is not the underlying abnormality.

Sagittal T2 TSE MR in this patient with lung cancer shows a focal mass at the C3 level
with adjacent cord edema
from a focal cord parenchymal metastasis.

Sagittal T1 C+ MR shows enhancement of focal cord metastasis
in this patient with lung carcinoma and worsening myelopathy.

TERMINOLOGY

Abbreviations

  • Acute transverse myelitis (ATM)

  • Multiple sclerosis (MS)

  • Neuromyelitis optica (NMO)

Synonyms

  • Acute noncompressive myelopathies

Definitions

  • Acute transverse myelopathy is a broad generic term encompassing heterogeneous group of disorders causing cord dysfunction

    • Etiologies include inflammatory causes (ATM) + vascular disease + radiation + paraneoplastic + idiopathic (unknown)

    • ATM more specific term for cord dysfunction that is inflammatory in etiology

      • –

        Inflammation defined by CSF findings and MR enhancement

IMAGING

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