Transverse myelitis - cervical

Case contributed by Dalia Ibrahim
Diagnosis almost certain

Presentation

Acute onset bilateral upper and lower limb weakness.

Patient Data

Age: 55 years
Gender: Female
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Sagittal
T2
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Sagittal
STIR
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Sagittal
T1
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Axial
T2
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Axial
T1
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T1 C+
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Sagittal T1
C+ fat sat
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Axial
T1 C+
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Sagittal
T2
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Info

The cervical cord is expanded over a long segment between C2-T1 level with diffuse symmetrical high signal change on T2/STIR, involving both sides of the cord.  Associated multiple intramedullary patchy areas of abnormal enhancement on postcontrat sequences.

Cervical spondylodegenrative changes.

C3-4 central posterior disc protrusion.

C4-5 posterior and left posterolateral disc protrusion.

C5-6 and C6-7 diffuse posterior disc bulges with central protrusions.

Bilateral C4-5, C5-6 & C6-7 degenerative neurocentral arthropathy.

MRI of the dorsal spine showed normal appearance of the dorsal spinal cord.

 

FU 2mth post corticosteroid Rx

mri
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Sagittal
T1
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Sagittal
T2
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Sagittal
STIR
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Axial
T2
This study is a stack
Axial
T1
This study is a stack
Sagittal T1
C+ fat sat
This study is a stack
Sagittal
T1 C+
This study is a stack
Axial
T1 C+
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Info

Follow-up after corticosteroid treatment showed complete resolution of the cervical cord swelling and patchy contrast enhancement.

Stationary course regarding the cervical spondylosis and disc lesions.

Annotated image
Sagittal
T2
Sagittal
T1C+
Download
Info

Follow-up after corticosteroid treatment showed complete resolution of the cervical cord swelling and patchy contrast enhancement.

Case Discussion

Clinical and first MRI were both favoring the diagnosis of transverse myelitis, after which the patient received corticosteroid treatment. The patient showed clinical improvement after treatment. The second MRI showed a complete resolution of the cord swelling and patchy contrast enhancement.

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