Nontraumatic Spinal Cord Compression: MRI Primer for Emergency Department Radiologists.

Area of Science:

• Radiology
• Neurology
• Emergency Medicine

Background:

• Acute myelopathy in a non-traumatic setting is a medical emergency.
• Spinal MRI is the primary diagnostic tool for evaluating acute myelopathy.
• Accurate diagnosis is critical to prevent permanent neurological deficits.

Purpose of the Study:

• To outline the differential diagnoses of acute myelopathy.
• To differentiate between compressive and non-compressive causes of myelopathy.
• To emphasize the importance of MRI findings in guiding urgent patient management.

Main Methods:

• Review of spinal MRI findings in acute myelopathy.
• Categorization of myelopathy by spinal canal compartment: epidural, intradural extramedullary, and intramedullary.
• Correlation of imaging findings with clinical and laboratory data.

Main Results:

• Compressive myelopathy shows thecal sac effacement and epidural fat obliteration.
• Non-compressive myelopathy presents as intramedullary T2-hyperintensity without a mass.
• A compartmental MRI approach aids in localizing lesions and refining diagnoses.

Conclusions:

• Spinal MRI is essential for diagnosing acute nontraumatic myelopathy.
• Differentiating compressive from non-compressive causes guides treatment decisions.
• Timely diagnosis and management are key to improving patient outcomes.