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Vasculitis of the spinal cord
Allan H Ropper1, Cenk Ayata, Lester Adelman
1Neurology Service, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Mass. 02135, USA. aropperm@cchcs.org
Archives of Neurology
|December 17, 2003
Summary
Central nervous system vasculitis rarely affects the spinal cord. This case highlights unusual pathology in spinal cord vasculitis, emphasizing its consideration in subacute myelopathy unresponsive to typical treatments.
Area of Science:
- Neurology
- Pathology
- Immunology
Background:
- Central nervous system vasculitis is uncommon, typically affecting cerebral hemispheres.
- Spinal cord involvement in vasculitis is exceptionally rare.
Observation:
- A young man presented with progressive leg weakness and sensory disturbances, mimicking multiple sclerosis.
- Cerebrospinal fluid analysis revealed lymphocytic pleocytosis and elevated protein, with normal MRI scans.
- Neurologic decline persisted despite initial improvement with corticosteroid therapy.
Findings:
- Pathologic examination revealed ischemic lesions and vasculitis affecting leptomeningeal and subpial vessels in the spinal cord.
- Vessel lumens were occluded by fibrinous material without significant necrosis.
- Similar findings were noted in cerebral hemorrhagic infarction.
Implications:
- Spinal cord vasculitis should be considered in subacute myelopathy with persistent cerebrospinal fluid abnormalities and steroid responsiveness.
- Normal spinal cord MRI does not exclude vasculitis.
- This case underscores the importance of clinicopathologic correlation for diagnosing rare neurological conditions.