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    This review aids clinicians in recognizing and differentiating hereditary myelopathies, a group of inherited spinal cord disorders. Understanding clinical patterns aids diagnosis of these complex neurological conditions.

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    Area of Science:

    • Neurology
    • Genetics
    • Clinical Medicine

    Background:

    • Hereditary myelopathies encompass diverse inherited neurological disorders affecting the spinal cord.
    • These conditions often involve extraspinal structures like peripheral nerves and the cerebellum, aiding diagnosis.
    • Spinal dysraphisms are excluded due to differing etiology and heritability.

    Purpose of the Study:

    • To guide clinicians in the clinical recognition of hereditary myelopathies.
    • To assist in the differential diagnosis of these inherited spinal cord disorders.
    • To highlight the spectrum and clinical paradigms of hereditary myelopathies.

    Main Methods:

    • Review of clinical features and diagnostic approaches for hereditary myelopathies.
    • Classification of hereditary myelopathies into four main clinical paradigms.
    • Illustration of clinical examples to emphasize diagnostic challenges.

    Main Results:

    • Hereditary myelopathies involve the spinal cord (dorsal columns, dorsal root ganglia, corticospinal tracts, anterior horn cells) and extraspinal structures.
    • Four primary clinical paradigms are identified: spinocerebellar ataxia, motor neuron disorder, leukodystrophy, and predominantly CNS distal motor-sensory axonopathy.
    • Extraspinal manifestations are crucial for recognizing specific hereditary myelopathy syndromes.

    Conclusions:

    • Classifying hereditary myelopathies facilitates clinical recognition and differential diagnosis.
    • Understanding the four clinical paradigms aids in diagnosing these complex inherited neurological conditions.
    • This review provides a framework for clinicians managing patients with suspected hereditary myelopathies.