Acute Myelopathy from ADEM to Zika

Acute-onset extremity weakness and paresthesia are among the most common indications for emergent spinal MR imaging. The aim of this article is to broaden readers' differential diagnostic armamentarium and reporting accuracy in the setting of suspected acute or progressive myelopathy by presenting a review of common and uncommon causes of spinal cord disease with a focus on key distinguishing clinical and imaging findings organized into related groups of diseases. The review covers spinal cord anatomy; discusses typical MR imaging findings in various nontraumatic etiologies of myelopathy and spinal neuropathy, as well as specific MR imaging findings; and examines the imaging, demographic, and clinical factors that can help us condense otherwise nonspecific findings into a focused differential or a single, discrete diagnosis. Topics covered include vascular, infectious and postinfectious, granulomatous, neoplastic, compressive, demyelinating, and toxic and metabolic diseases. Review of this material can increase our confidence in rendering a targeted diagnosis or differential diagnosis and can make a significant impact on the downstream work-up and treatment of the patient.

Learning Objective: To recognize spine abnormalities on MR imaging and identify circumstantial clinical and demographic features that can narrow or isolate the differential diagnosis in patients who present with acute or progressive myelopathy.