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Longitudinally extensive myelopathy in children
Danielle Eckart Sorte1, Andrea Poretti, Scott D Newsome
1Division of Interventional Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Abstract:
When children present with acute myelopathy manifested by sensory, motor, or bowel and bladder symptoms, MRI of the neuraxis with contrast agent is the most important imaging study to obtain. Although occasionally normal, MRI often demonstrates signal abnormality within the spinal cord. Classically, longitudinally extensive transverse myelitis (≥3 vertebral bodies in length) has been described with neuromyelitis optica (NMO), but alternative diagnoses should be considered. This pictorial essay reviews the differential diagnoses that may present with longitudinally extensive spinal cord signal abnormalities. Multiple inflammatory, infectious, vascular, metabolic and neurodegenerative etiologies can present with a myelopathy. Thus, radiologists can assist in the diagnosis by familiarizing themselves with the spectrum of diseases in childhood that result in longitudinally extensive signal abnormalities in the absence of trauma.
Insights
Pediatric acute myelopathy requires MRI of the neuraxis. This study reviews differential diagnoses for longitudinally extensive spinal cord signal abnormalities in children, excluding trauma.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Spinal Cord Imaging
Background:
- Acute myelopathy in children presents with sensory, motor, or bowel/bladder dysfunction.
- Magnetic Resonance Imaging (MRI) of the neuraxis with contrast is crucial for diagnosis.
- Longitudinally extensive transverse myelitis is classically associated with Neuromyelitis Optica (NMO), but other causes exist.
Purpose of the Study:
- To review differential diagnoses for longitudinally extensive spinal cord signal abnormalities in pediatric patients.
- To highlight the role of radiologists in identifying diverse etiologies of myelopathy in children.
Main Methods:
- Pictorial essay format reviewing imaging findings.
- Focus on MRI demonstrating signal abnormalities within the spinal cord.
- Discussion of various etiological categories presenting as myelopathy.
Main Results:
- MRI frequently shows spinal cord signal abnormalities in pediatric acute myelopathy.
- Longitudinally extensive abnormalities can stem from multiple causes beyond NMO.
- Differential diagnoses include inflammatory, infectious, vascular, metabolic, and neurodegenerative conditions.
Conclusions:
- Radiologists must be aware of the broad spectrum of diseases causing longitudinally extensive spinal cord signal abnormalities in children.
- Accurate diagnosis aids in appropriate management of pediatric myelopathy.
- Distinguishing these findings from trauma-related injuries is essential.
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