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A 66-Year-Old Woman with a Progressive, Longitudinally Extensive, Tract Specific, Myelopathy
Elizabeth O'Keefe1, Katherine E Schwetye2, John Nazarian3
1Department of Neurology, Division of Physical Medicine and Rehabilitation, Washington University School of Medicine, Campus Box 8518, 4444 Forest Park Blvd., St. Louis, MO 63108, USA.
Case Reports in Neurological Medicine
|December 20, 2016
Summary
This case study describes a rare progressive spinal cord ischemia causing severe sensory deficits. Autopsy revealed polyphasic ischemia as the cause of this unique spinal cord tractopathy.
Area of Science:
- Neurology
- Pathology
- Vascular Medicine
Background:
- Myelopathy of unclear etiology can present with debilitating sensory deficits.
- Spinal cord ischemia, particularly affecting the posterior cord, is an uncommon cause of myelopathy.
Purpose of the Study:
- To present a unique case of progressive spinal cord ischemia.
- To highlight the diagnostic challenges and autopsy findings in a rare myelopathy.
Main Methods:
- A 66-year-old woman with progressive sensory deficits underwent comprehensive diagnostic workup including MRI and laboratory analyses.
- Treatment with methylprednisolone and immunoglobulin was ineffective.
- Autopsy was performed to determine the underlying pathology.
Main Results:
- Spinal cord MRI revealed a longitudinally extensive T2-hyperintense lesion in the dorsal columns.
- Despite extensive investigations, the etiology remained unclear during the patient's lifetime.
- Autopsy findings were most consistent with polyphasic spinal cord ischemia affecting dorsal and lateral white matter tracts.
Conclusions:
- This case represents a rare instance of progressive spinal cord tractopathy attributed to chronic spinal cord ischemia.
- The underlying cause of the progressive vasculopathy remains unknown.
- The case underscores the importance of considering rare etiologies in progressive myelopathies.
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