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Differential Diagnoses for a Myelopathy on Exam

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Extrinsic Compression of the Cord

  • Trauma

    • Even minor trauma, such as hyperextension of the neck, may cause spinal cord compression in patients with degenerative joint disease of the spine.

  • Infection

    • Most often occur in the thoracic or lumbar spine

    • Can take the following forms:

    1) Epidural Abscesses: most commonly seen in IV drug users, often bacterial (Staph aureus, E. coli)

    2) Spinal Tuberculosis (Pott’s Disease): debilitated or immunocompromised patients, known pulmonary Tb

    3) Vertebral Osteomyelitis

    4) Discitis

  • Neoplasm

    • Metastases: prostate, lung, breast, colon, myeloma, lymphoma

    • In metastatic disease, the thoracic spine is most often affected because of venous drainage of visceral organs through spinal extradural venous plexuses.

    • Others: meningiomas, neurofibromas, schwannomas, ependymomas

  • Degenerative disease

    • Cervical disks herniate centrally causing myelopathies, while lumbar disks herniated laterally and cause radicular symptoms

  • Congenital disease

    • Arnold Chiari malformation +/- syringomyelia

    • Defects of atlantoaxial jointmay predispose to subluxation or dislocation

    • Tethered cord may produce a spastic diplegia of the legs

  • Inflammatory disease

    • Rheumatoid arthritis may predispose to atlantoaxial translocations

  • Vascular disease

    • Epidural or subdural hematomas with predisposing factors being therapeutic anticoagulation, trauma, tumor, blood dyscrasia, rarely side effect of lumbar puncture or epidural anesthesia

    • Hematomyelia

    • AVM’s

Intrinsic Disease of the Cord

  • Inflammatory disease

    • Demyelinating Lesion (MS, NMO)

    • Vasculitis

  • Infection

    • HIV, HTLVI/II, RPR, Lyme

  • Vascular disease

    • Spinal Cord Infarct

  • Nutritional

    • Cu deficiency