Causes of Intramedullary Myelopathy

Question 1

Recurrent episodes of myelitis and optic neuritis WITHOUT the brain lesions typical of MS
NMO-IgG autoantibody may be present

Answer 1

Neuromyelitis Optica ( Devic Disease)

Question 2

Subacute onset of weakness, sensory changes, bowel/bladder dysfunction, typically after a viral infection

Distinguished from MS by the presence of complete myelitis, no oligoclonal bands or elevated IgG index in the CSF and no lesions on brain MRI

Answer 2

Idiopathic Transverse Myelitis

Question 3

Paresthesias, Lower Extremity weakness and gait instability
Findings may include paraparesis, vibration and position sense loss and sensory ataxia
Anemia may be absent

Answer 3

Vitamin B12 deficiency

Question 4

Mimics B12 Deficiency and may develop after bariatric surgery or from excessive zinc oxide ingestion

Answer 4

Copper Deficiency

Question 5

Acute onset of Flaccid Paralysis or weakness and pinprick sensation loss below the level of the infarction
Potential causes include emboli, hypotension during cardiovascular/ aortic surgery and AV malformation

Answer 5

Infarction of the Spinal Cord

Question 6

How should you treat spinal cord compression caused by metastatic disease?

Answer 6

High dose glucocorticoids > surgical decompression> radiation

Question 7

Spinal cord compression caused by which cancers should be preferentially treated with radiation rather than surgery?

Answer 7

Leukemia, Myeloma, Lymphoma, Germ Cell Tumor

Question 8

In which situations should you avoid giving steroids to treat cord compression?

Answer 8

Infection or Hematoma