Spinal cord inflammation

1-Spinal cord inflammation is a syndrome known as transverse myelitis.

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2-Causes of this syndrome are the following:

-Multiple sclerosis.

-ADEM syndrome which is acute disseminated encephalomyelitis.

-Sarcoidosis.

-Behcet syndrome.

-Radiation myelopathy.

-Necrotizing myelopathy.

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3-All the causes of this syndrome have the same radiological findings which are:

-T1---Low signal intensity.

-T2---High signal intensity.

-Cord enlargement---Could be present or not.

-Enhancement---Could be present or not.

Diagnosis usually are made using the clinical data.

4-The combination of the transverse myelitis with optic nerve neuritis is called Devic's syndrome.

The most common cause of Devic's syndrome is multiple sclerosis.

5-The combination between transverse myelitis and presence of changes in the brain give diagnosis of multiple sclerosis or ADEM syndrome.

6-Multiple sclerosis:

-Its patches usually not seen in the T1 image while seen as a hyper intense patches in T2 image.
-If taking contrast, this means that the lesion is active.
-If the patches is seen in the brain you can diagnose MS or ADEM syndrome.

7-ADEM:

- Patient should has a history of viral illness or recent vaccination about 10-15 days before appearance of the spinal patches.
-It can gives also lesions in the brain as MS, so the only way to differentiate between them is by clinical history and by no enhancement of the patches in ADEM, but remember that MS plaques if it is not active it will not take contrast as in ADEM.
-Very important difference between ADEM and MS is that in the former you can find hemorrhage in T1 and T2 images which is not seen in the latter.

8-Radiation myelopathy:

-History of radiation at the region of the plaques.
-Or presence of yellow fat in the bone marrow in the area where radiation was done.


9-Sarcoid:


-To diagnose it you should have one of the following:
*History(a lady suffering from coughing with multiple lymph nodes enlargement with chest manifestation, brain and spinal cord manifestation).
*Leptomeningeal enhancement(pathognomonic for sarcoid).
*Other imaging findings in the chest.