From the Guidelines
Acute myelopathy is a sudden-onset neurological condition characterized by damage or dysfunction of the spinal cord, resulting in various symptoms including muscle weakness, sensory changes, pain, and bowel or bladder dysfunction. The condition can be subdivided into noninflammatory and inflammatory causes, with noninflammatory conditions including extrinsic compression of the spinal cord, vascular pathologies, and trauma, while inflammatory conditions include demyelinating diseases, systemic inflammatory diseases, and infection 1. Common causes of acute myelopathy include trauma, inflammation (transverse myelitis), infection, vascular problems (like spinal cord infarction), compression from tumors or herniated discs, and autoimmune disorders. Some key points to consider in the diagnosis and management of acute myelopathy include:
- Evaluation for extrinsic compression of the spinal cord is necessary in all patients with acute onset myelopathy 1
- MRI imaging of the spine, sometimes with contrast, is a crucial diagnostic tool, along with blood tests, cerebrospinal fluid analysis, and neurological examination 1
- Treatment varies based on the underlying cause, but may include high-dose corticosteroids (methylprednisolone 1000mg IV daily for 3-5 days) for inflammatory causes, surgical decompression for structural issues, antibiotics for infections, or immunomodulatory therapies for autoimmune conditions
- Prompt diagnosis and treatment are crucial, as delays can lead to permanent neurological damage
- Physical and occupational therapy are often necessary components of recovery, and some patients may require long-term rehabilitation to regain function The use of IV contrast or MRI spine area of interest without IV contrast is usually appropriate for the initial imaging of patients with acute onset myelopathy, with these procedures being equivalent alternatives 1. Overall, a comprehensive approach to diagnosis and management is necessary to optimize outcomes in patients with acute myelopathy.
From the Research
Definition of Acute Myelopathy
- Acute myelopathy is a term referring to any pathologic process affecting the spinal cord, encompassing a broad spectrum of etiologies 2.
- It is considered acute when the symptoms progress to their nadir in maximum 21 days after onset 2.
- Acute myelopathies are spinal cord disorders characterized by a rapidly progressive course reaching nadir within hours to a few weeks that may result in severe disability 3.
Characteristics of Acute Myelopathy
- The multitude of underlying etiologies, complexities in confirming the diagnosis, and often unforgiving nature of spinal cord damage have always represented a challenge 3.
- Awareness of the clinical and magnetic resonance imaging characteristics of different myelopathies and the specific settings where they occur is fundamental for a correct diagnosis 3.
- Neuroimaging helps distinguish compressive etiologies that may require urgent surgery from intrinsic etiologies that generally require medical treatment 3.
Etiologies of Acute Myelopathy
- A variety of inflammatory, infective, demyelinating, and autoimmune disorders present with acute transverse myelopathy 4.
- The etiologies of acute myelopathy include idiopathic acute transverse myelitis, neuromyelitis optica spectrum disorders, multiple sclerosis, and infectious or parainfectious myelitis 4.
- Immune-mediated myelopathies are a subgroup of disorders with an autoimmune and inflammatory-based pathology 5.
Diagnosis and Management
- Prompt recognition of the underlying etiology is essential so that a specific targeted therapy can be implemented for optimal outcomes 5.
- A systematic approach to immune-mediated myelopathies, with a focus on the unique characteristics of each, may aid in diagnosis 5.
- Early institution of methylprednisolone therapy reduces the disability in patients with acute transverse myelopathy 4.