|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 55-56
Nonscalpel myelopathy: Cervical myelopathy secondary to neuromyelitis optica
Mohit Patel1, Hesham Abboud2, Manish K Kasliwal1
1 Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
2 Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
|Date of Submission||16-Feb-2020|
|Date of Acceptance||25-Feb-2020|
|Date of Web Publication||4-Apr-2020|
Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Patel M, Abboud H, Kasliwal MK. Nonscalpel myelopathy: Cervical myelopathy secondary to neuromyelitis optica. J Craniovert Jun Spine 2020;11:55-6
|How to cite this URL:|
Patel M, Abboud H, Kasliwal MK. Nonscalpel myelopathy: Cervical myelopathy secondary to neuromyelitis optica. J Craniovert Jun Spine [serial online] 2020 [cited 2022 Aug 14];11:55-6. Available from: https://www.jcvjs.com/text.asp?2020/11/1/55/281905
A 36-year-old female presented with complaints of numbness in all four extremities and hand weakness for 2 weeks with an examination notable for diminished posterior column function, weakness involving hand intrinsic muscles, and evidence of hyperreflexia. Magnetic resonance imaging (MRI) of the cervical spine showed T1 hypointensity [Figure 1]a, a long-segment T2 hyperintensity [Figure 1]b with patchy intramedullary enhancement [Figure 1]c, but no significant cord enlargement. She was referred to us with a diagnosis of an intramedullary spinal tumor for possible surgery. However, careful imaging evaluation demonstrating longitudinally extensive spinal cord lesion led to consideration of neuromyelitis optica (NMO) as a possible diagnosis. MRI of the brain was normal. A lumbar puncture was performed and she was treated with intravenous steroids and plasmapheresis. Her symptoms of hand weakness and numbness resolved almost completely, and an MRI performed a week later showed significant improvement in imaging findings [Figure 1]d, [Figure 1]e,[Figure 1]f – T1-weighted, T2-weighted, and postcontrast, respectively]. Her NMO-IgG antibody test was negative and so was the cerebrospinal fluid for oligoclonal bands. NMO is a chronic disorder of central nervous system characterized by optic neuritis and myelitis. It often presents on imaging as a longitudinally extensive transverse myelitis with long-segment T2 hyperintensity (>3 vertebral segments) and absence of significant spinal cord enlargement. Rapid onset of symptoms and recognition of this imaging findings should lead to avoidance of any surgical intervention as medical management remains the treatment of choice following confirmation of diagnosis. The importance of being cognizant of this non-compressive myelopathy for spine surgeons cannot be overemphasized.
|Figure 1: Magnetic resonance imaging of the cervical spine demonstrating T1 hypointensity (a), a long-segment T2 hyperintensity (b) patchy intramedullary enhancement (c) but no significant cord enlargement (a-c). Posttreatment magnetic resonance imagingperformed a week later demonstrating significant improvement in imaging findings (d, T1-weighted; e, T2-weighted; and f, postcontrast)|
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