Utility of extension views in spondylotic myelopathy mimicking transverse myelitis

Cervical spondylotic myelopathy is a common cause of myelopathy and may mimic transverse myelitis. We report a 55 year-old lady with subacute myelopathy initially treated with glatiramer acetate for suspected clinically isolated syndrome. MRI head and spine revealed a single short cervical cord T2-hyperintense lesion with enhancement just below a region of moderate stenosis. Cerebrospinal fluid revealed elevated oligoclonal bands. Repeat MRI 7 months later showed persistent enhancement. Dynamic MRI revealed cord compression during extension. Surgical decompression resulted in marked clinical and radiologic improvement. This case highlights the utility of extension MRI in cervical myelopathy of uncertain etiology.