PMID- 37207546
OWN - NLM
STAT- MEDLINE
DCOM- 20230613
LR  - 20230613
IS  - 1878-5883 (Electronic)
IS  - 0022-510X (Linking)
VI  - 450
DP  - 2023 Jul 15
TI  - Identifying specific myelopathy etiologies in the evaluation of suspected 
      myelitis: A retrospective analysis.
PG  - 120677
LID - S0022-510X(23)00137-5 [pii]
LID - 10.1016/j.jns.2023.120677 [doi]
AB  - BACKGROUND: Myelopathies require prompt etiologic diagnosis. We aimed to identify 
      a specific myelopathy diagnosis in cases of suspected myelitis to highlight 
      clinicoradiologic differences. METHODS: In this retrospective, single-centre 
      cohort of subjects with suspected myelitis referred to London Multiple Sclerosis 
      (MS) Clinic between 2006 and 2021, we identified those with MS and reviewed the 
      remaining charts for etiologic diagnosis based on clinical, serologic, and 
      imaging details. RESULTS: Of 333 included subjects, 318/333 (95.5%) received an 
      etiologic diagnosis. Most (274/333, 82%) had MS or clinically isolated syndrome. 
      Spinal cord infarction (n = 10) was the commonest non-inflammatory myelitis mimic 
      characterized by hyperacute decline (n = 10/10, 100%), antecedent claudication 
      (n = 2/10, 20%), axial owl/snake eye (n = 7/9, 77%) and sagittal pencillike 
      (n = 8/9, 89%) MRI patterns, vertebral artery occlusion/stenosis (n = 4/10, 40%), 
      and concurrent acute cerebral infarct (n = 3/9, 33%). Longitudinal lesions were 
      frequent in aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder 
      (AQP4+NMOSD) (n = 7/7, 100%) and myelin oligodendrocyte 
      glycoprotein-IgG-associated disorder (MOGAD) (n = 6/7, 86%), accompanied by 
      bright spotty (n = 5/7, 71%) and central-grey-restricted (n = 4/7, 57%) 
      T2-lesions on axial sequences, respectively. Leptomeningeal (n = 4/4, 100%), 
      dorsal subpial (n = 4/4, 100%) enhancement, and positive body PET/CT (n = 4/4, 
      100%) aided the diagnosis of sarcoidosis. Spondylotic myelopathies had chronic 
      sensorimotor presentations (n = 4/6, 67%) with relative bladder sparing (n = 5/6, 
      83%), localizable to sites of disc herniation (n = 6/6, 100%). Metabolic 
      myelopathies showed dorsal column or inverted 'V' sign (n = 2/3, 67%) MRI 
      T2-abnormality with B12 deficiency. CONCLUSIONS: Although no single feature 
      reliably confirms or refutes a specific myelopathy diagnosis, this study 
      highlights patterns that narrow the differential diagnosis of myelitis and 
      facilitate early recognition of mimics.
CI  - Copyright (c) 2023 Elsevier B.V. All rights reserved.
FAU - Alkabie, Samir
AU  - Alkabie S
AD  - Department of Clinical Neurological Sciences, London Health Sciences Centre, 
      Schulich Medicine and Dentistry, Western University, London, Ontario, Canada.
FAU - Casserly, Courtney S
AU  - Casserly CS
AD  - Department of Clinical Neurological Sciences, London Health Sciences Centre, 
      Schulich Medicine and Dentistry, Western University, London, Ontario, Canada.
FAU - Morrow, Sarah A
AU  - Morrow SA
AD  - Department of Clinical Neurological Sciences, London Health Sciences Centre, 
      Schulich Medicine and Dentistry, Western University, London, Ontario, Canada.
FAU - Racosta, Juan M
AU  - Racosta JM
AD  - Department of Clinical Neurological Sciences, London Health Sciences Centre, 
      Schulich Medicine and Dentistry, Western University, London, Ontario, Canada; MS 
      Epidemiology Lab, London, Ontario, Canada. Electronic address: 
      Juan.Racosta@lhsc.on.ca.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230512
PL  - Netherlands
TA  - J Neurol Sci
JT  - Journal of the neurological sciences
JID - 0375403
RN  - 0 (Myelin-Oligodendrocyte Glycoprotein)
RN  - 0 (Autoantibodies)
RN  - 0 (Aquaporin 4)
RN  - 0 (Immunoglobulin G)
SB  - IM
MH  - Humans
MH  - Retrospective Studies
MH  - Positron Emission Tomography Computed Tomography/adverse effects
MH  - Myelin-Oligodendrocyte Glycoprotein
MH  - Autoantibodies
MH  - *Myelitis/diagnostic imaging/etiology
MH  - *Neuromyelitis Optica/complications/diagnostic imaging
MH  - *Spinal Cord Diseases/etiology/complications
MH  - Aquaporin 4
MH  - Immunoglobulin G
OTO - NOTNLM
OT  - Autoimmune myelitis
OT  - Clinically isolated syndrome
OT  - Differential diagnosis
OT  - Idiopathic
OT  - Mimics
OT  - Multiple sclerosis
OT  - Myelin oligodendrocyte glycoprotein antibody associated disorder
OT  - Myelopathies
OT  - Neuromyelitis optica spectrum disorder
OT  - Spinal cord infarction
COIS- Declaration of Competing Interest The authors have no competing interests to 
      declare relevant to the content of this work.
EDAT- 2023/05/20 09:42
MHDA- 2023/06/13 06:42
CRDT- 2023/05/19 18:07
PHST- 2023/01/30 00:00 [received]
PHST- 2023/04/13 00:00 [revised]
PHST- 2023/05/09 00:00 [accepted]
PHST- 2023/06/13 06:42 [medline]
PHST- 2023/05/20 09:42 [pubmed]
PHST- 2023/05/19 18:07 [entrez]
AID - S0022-510X(23)00137-5 [pii]
AID - 10.1016/j.jns.2023.120677 [doi]
PST - ppublish
SO  - J Neurol Sci. 2023 Jul 15;450:120677. doi: 10.1016/j.jns.2023.120677. Epub 2023 
      May 12.