Spinal Cord Compression and Myelopathies

Patients with signs and symptoms of acute myelopathy require urgent neurologic evaluation focused upon the identifi cation and management of treatable disorders. MRI of the spine is the imaging modality of choice to evaluate for a compressive lesion. When cord compression is present, surgical treatment is usually indicated. When compression is not detected, an analysis of precise lesion localization, nonneurological clinical features, MRI fi ndings, and serologic studies narrow the differential diagnosis. The key diagnostic considerations include demyelinating, vascular, infl ammatory, infectious, and paraneoplastic disorders. Empiric high-dose corticosteroid treatment is often indicated in noncompressive myelopathy; additional investigations are important to identify patients with relapsing or progressive disorders who may benefi t from preventive therapies. Patients whose symptoms continue to progress after initial immunosuppressive treatment may benefi t from plasmapheresis and occasionally from biopsy for defi nitive diagnosis.