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Journal of Craniovertebral Junction and Spine
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LETTER TO EDITOR
Year : 2020  |  Volume : 11  |  Issue : 1  |  Page : 55-56  

Nonscalpel myelopathy: Cervical myelopathy secondary to neuromyelitis optica


1 Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
2 Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

Date of Submission16-Feb-2020
Date of Acceptance25-Feb-2020
Date of Web Publication4-Apr-2020

Correspondence Address:
Mohit Patel
Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcvjs.JCVJS_18_20

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How to cite this article:
Patel M, Abboud H, Kasliwal MK. Nonscalpel myelopathy: Cervical myelopathy secondary to neuromyelitis optica. J Craniovert Jun Spine 2020;11:55-6

How to cite this URL:
Patel M, Abboud H, Kasliwal MK. Nonscalpel myelopathy: Cervical myelopathy secondary to neuromyelitis optica. J Craniovert Jun Spine [serial online] 2020 [cited 2020 Nov 25];11:55-6. Available from: https://www.jcvjs.com/text.asp?2020/11/1/55/281905



Dear Editor,

A 36-year-old female presented with complaints of numbness in all four extremities and hand weakness for 2 weeks with an examination notable for diminished posterior column function, weakness involving hand intrinsic muscles, and evidence of hyperreflexia. Magnetic resonance imaging (MRI) of the cervical spine showed T1 hypointensity [Figure 1]a, a long-segment T2 hyperintensity [Figure 1]b with patchy intramedullary enhancement [Figure 1]c, but no significant cord enlargement. She was referred to us with a diagnosis of an intramedullary spinal tumor for possible surgery. However, careful imaging evaluation demonstrating longitudinally extensive spinal cord lesion led to consideration of neuromyelitis optica (NMO) as a possible diagnosis. MRI of the brain was normal. A lumbar puncture was performed and she was treated with intravenous steroids and plasmapheresis. Her symptoms of hand weakness and numbness resolved almost completely, and an MRI performed a week later showed significant improvement in imaging findings [Figure 1]d, [Figure 1]e,[Figure 1]f – T1-weighted, T2-weighted, and postcontrast, respectively]. Her NMO-IgG antibody test was negative and so was the cerebrospinal fluid for oligoclonal bands. NMO is a chronic disorder of central nervous system characterized by optic neuritis and myelitis. It often presents on imaging as a longitudinally extensive transverse myelitis with long-segment T2 hyperintensity (>3 vertebral segments) and absence of significant spinal cord enlargement. Rapid onset of symptoms and recognition of this imaging findings should lead to avoidance of any surgical intervention as medical management remains the treatment of choice following confirmation of diagnosis. The importance of being cognizant of this non-compressive myelopathy for spine surgeons cannot be overemphasized.
Figure 1: Magnetic resonance imaging of the cervical spine demonstrating T1 hypointensity (a), a long-segment T2 hyperintensity (b) patchy intramedullary enhancement (c) but no significant cord enlargement (a-c). Posttreatment magnetic resonance imagingperformed a week later demonstrating significant improvement in imaging findings (d, T1-weighted; e, T2-weighted; and f, postcontrast)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




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