From the Guidelines
Acute myelopathy is a medical emergency that presents with sudden weakness or paralysis, sensory disturbances, pain, bowel and bladder dysfunction, and autonomic dysfunction, requiring prompt diagnosis and treatment to prevent permanent neurological damage. The symptoms of acute myelopathy can vary depending on the level of spinal cord involvement, but typically include:
- Sudden weakness or paralysis in the limbs
- Sensory disturbances, such as numbness, tingling, or loss of sensation below the level of injury
- Pain at the site of spinal cord damage that may radiate around the trunk or into the limbs
- Bowel and bladder dysfunction, manifesting as urinary retention, incontinence, or constipation
- Reflexes may be initially diminished (spinal shock) but later become hyperactive below the level of injury, with positive Babinski signs indicating upper motor neuron damage
- Autonomic dysfunction, causing problems with blood pressure regulation, sweating abnormalities, or temperature dysregulation 1. The underlying causes of acute myelopathy include trauma, compression from herniated discs or tumors, inflammation, infection, or vascular problems affecting the spinal cord's blood supply, and can be diagnosed using MRI, which is useful for evaluating the spinal cord and surrounding structures 1.
The symptoms of acute myelopathy can be caused by various conditions, including:
- Extrinsic compression of the spinal cord, such as degenerative disease, disc herniations, and malalignment
- Inflammatory conditions, such as demyelinating diseases, systemic inflammatory diseases, and infection
- Vascular problems, such as spinal cord ischemia, which can be caused by atheromatous disease, aortic surgery, or other conditions 1.
Early recognition of the symptoms of acute myelopathy is crucial, as prompt diagnosis and treatment can prevent permanent neurological damage. MRI is a useful diagnostic tool for evaluating the spinal cord and surrounding structures, and can help identify the underlying cause of acute myelopathy 1.
In patients with suspected acute myelopathy, MRI of the spine is recommended as the initial diagnostic evaluation, as it can provide valuable information about the spinal cord and surrounding structures, and can help identify the underlying cause of the condition 1. Diffusion-weighted imaging can also be useful in cases where spinal cord ischemia is suspected, as it can show signal alteration in the spinal cord earlier after symptom onset compared with T2-weighted images 1.
Overall, acute myelopathy is a serious medical condition that requires prompt diagnosis and treatment to prevent permanent neurological damage. Early recognition of the symptoms and prompt diagnostic evaluation with MRI are crucial for improving outcomes in patients with acute myelopathy.
From the Research
Symptoms of Acute Myelopathy
The symptoms of acute myelopathy can vary depending on the underlying etiology, but they are generally characterized by a rapidly progressive course, reaching a nadir within hours to a few weeks, and may result in severe disability 2.
Clinical Presentation
- Acute transverse myelopathy can present with a range of symptoms, including sensory, motor, and autonomic dysfunction 3.
- The clinical profile of patients with acute transverse myelopathy may include weakness, numbness, and bladder and bowel dysfunction 3.
- Longitudinally extensive transverse myelitis is a common finding in patients with acute transverse myelopathy, and is characterized by a lesion that extends over three or more vertebral segments 3.
Diagnostic Evaluation
- Magnetic resonance imaging (MRI) is a crucial diagnostic tool in the evaluation of acute myelopathy, and can help distinguish between compressive and intrinsic etiologies 2.
- Serum and cerebrospinal fluid parameters, as well as visual evoked potentials, may also be useful in the diagnostic workup of acute transverse myelopathy 3.
Treatment and Prognosis
- The treatment of acute myelopathy depends on the underlying etiology, and may include methylprednisolone therapy, plasma exchange, or cyclophosphamide 4.
- Early institution of methylprednisolone therapy may reduce disability in patients with acute transverse myelopathy, although the evidence is not consistent 3, 5, 6.
- Delayed initiation of methylprednisolone therapy, poor modified Barthel index at discharge, and extensive cord involvement are associated with severe residual disability 3.