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Unusual long-standing Gd-DTPA enhancement in a chronic progressive myelopathy
B Weinstock-Guttman1, J S Ross, R M Ransohoff
1Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, OH 44195, USA.
Abstract:
Chronic spinal syndromes without evidence of cord compression often represent a real diagnostic challenge. We report a case of chronic progressive myelopathy with an unusual long-standing gadolinium-diethylenetriamine pentaacetic acid (Magnevist, Berlex Laboratories) enhanced spinal cord lesion demonstrated on MRI, through a 14 month follow-up period. In the context of continuous neurological decline the patient underwent two biopsies at 1 year intervals. The final diagnosis was obtained only after the second biopsy, which demonstrated a demyelinating plaque with reactive astrocytosis. The clinical condition of our patient has been stable for 5 years. A repeated workup including MRI of the cervical and thoracic spine demonstrated a mildly atrophic cord in the upper thoracic region, with no evidence of pathological signal or enhancement at this time. Brain MRI and visual evoked potentials were normal. This case provides interesting clinical, pathological, and MRI correlations in a longitudinal follow-up of a spinal demyelinating lesion.
Insights
Diagnosing chronic spinal conditions can be difficult. This case highlights a rare, long-standing spinal cord lesion diagnosed as a demyelinating plaque after two biopsies, leading to stable neurological function.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Chronic spinal syndromes without cord compression pose diagnostic challenges.
- Magnetic Resonance Imaging (MRI) is crucial for visualizing spinal cord lesions.
Observation:
- A patient presented with chronic progressive myelopathy and a persistent gadolinium-enhanced spinal cord lesion over 14 months.
- Neurological decline prompted two biopsies, separated by one year.
Findings:
- The second biopsy revealed a demyelinating plaque with reactive astrocytosis as the cause of myelopathy.
- Following diagnosis, the patient's clinical condition stabilized for five years.
Implications:
- This case underscores the importance of serial biopsies for diagnosing challenging spinal cord pathologies.
- Longitudinal MRI and pathological correlation are vital for understanding demyelinating lesions.