Spinal cord infarction in a patient with multiple sclerosis

Area of Science:

• Neurology
• Neuroimmunology
• Vascular Neurology

Background:

• Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system.
• Myelitis, or inflammation of the spinal cord, is a common manifestation of MS.
• Distinguishing MS-related myelitis from other spinal cord pathologies is crucial for appropriate management.

Observation:

• A 49-year-old woman with relapsing-remitting MS presented with symptoms suggestive of a severe myelitis attack.
• Diagnostic workup revealed the condition was a spinal cord infarction (SCI), not an MS exacerbation.
• The patient's clinical presentation, laboratory results, and radiographic imaging were key to the diagnosis.

Findings:

• Spinal cord infarction can present with clinical features overlapping with inflammatory myelitis in MS patients.
• Specific clinical, laboratory, and radiographic characteristics aid in differentiating SCI from MS-induced myelitis.
• This case underscores the importance of considering non-inflammatory etiologies in MS patients experiencing myelitic symptoms.

Implications:

• Accurate diagnosis of spinal cord infarction versus MS myelitis is essential for timely and appropriate treatment.
• Understanding the differential diagnosis can prevent misdiagnosis and guide therapeutic strategies in neuroinflammatory and neurovascular conditions.
• This case contributes to the literature on challenging differential diagnoses in patients with established multiple sclerosis.