Spinal Cord Infarction Versus Idiopathic Transverse Myelitis: Clinical, Radiological, and Functional Insights From a...

Spinal cord infarction (SCI) is a rare but devastating myelopathy, characterized by a high disability rate and an unfavorable prognosis. It has often been underdiagnosed and misdiagnosed as idiopathic transverse myelitis (ITM). This study aimed to describe the clinical features, radiological biomarkers, treatments, and functional outcome of SCI, distinguishing it from ITM.

A retrospective observational cohort study included patients who met the diagnostic criteria of SCI and ITM from January 2019 to October 2024. The clinical, radiological data, and diagnosis were recorded, and the functional outcomes were reached via telephone and face-to-face evaluations. Univariate analysis was used to differentiate the two groups.

During the study period, a total of 22 SCI patients with a median age of 53.0 years (interquartile range (IQR): 41.8 to 60.2) were enrolled. Thirteen patients underwent the diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) sequence, among whom 12 were confirmed as having definite SCI. Compared with ITM, SCI has the following characteristics. The time from onset to nadir in SCI is much shorter, mostly within 6 h (p < 0.001). On sagittal MRI, SCI often manifests as linear lesions, while ITM tends to present as patchy and fusiform lesions (p < 0.001). We have also defined a lesion characteristic of SCI based on T2-weighted sequences, termed the "eccentric sign". Moreover, patients with SCI generally have a poorer prognosis and higher dependence.

SCI can be diagnosed and differentiated from ITM based on clinical features and radiological signs.