Imaging of Acquired Toxic and Metabolic Disorders of the Spinal Cord

Metabolic and toxic myelopathies constitute a clinically significant subset of spinal cord disorders, often presenting with overlapping neurologic and imaging features. They primarily result from nutritional deficiencies or toxic exposures such as nitrous oxide, radiation, drugs, and systemic conditions. Patients typically exhibit subacute or progressive myelopathy with dorsal and lateral column involvement. MR imaging is the imaging modality of choice, often demonstrating characteristic longitudinal and symmetric signal abnormalities. Diagnosis requires integration of clinical findings, laboratory evaluation, and imaging, with exclusion of alternative etiologies. Early recognition is critical, as many causes are potentially reversible with timely treatment.