Cervical spondylotic myelopathy in the differential diagnosis of autoimmune myelitis

Address for correspondence: Ana Carolina Dietrich (email: [e-mail]).

Abstract

Case Presentation: A 36-year-old woman with hypoesthesia in the upper limbs for 30 days, progressing to weakness in the hands and lower limbs, experienced shocks going down her spine. She denied history of trauma. Upon examination, she had grade-4 bilateral tetraparesis, sign of pyramidal lesion, and hypoesthesia. The patient underwent cervical spine magnetic resonance imaging, which revealed spondylotic myelopathy at C4-C5. The patient underwent anterior C4-C5 cervical discectomy with fusion, without complications.

Discussion: Spondylotic myelopathy manifests as an aggravation of cervical spondylosis, causing stenosis of the vertebral canal. The manifestations are spinal cord ischemia and lesions in neurons related to the affected nerve roots. It is the main spinal neuropathy in the adult population, but its diagnosis is still discussed. Due to similar symptoms and less specific exams, it is a major differential diagnosis of autoimmune myelitis. Suspicion increases when there are gait changes with sensory or motor complaints in the upper limbs in individuals over 55 years of age. Autoimmune myelitis is an incapacitating neurological syndrome characterized by weakness, sensibility alterations, and autonomic dysfunction. The symptoms present with a sudden onset, with lower back pain, sensation of a tight belt around the affected area, headaches, and cervical dorsalgia. Cervical magnetic resonance is the primary method of diagnosis, followed by testing of the spinal fluid, serological tests, and antibody tests. It generally occurs in an isolated form, or as a secondary complication, in which case secondary infections and infiltration of leukocytes in wounded parts of the spinal cord are the main etiological factors.

Final Comments: Cervical Spondylotic Myelopathy presents a diagnostic challenge due to the lack of specific findings and the large number of differential diagnoses. It is important to be careful when interpreting symptoms and test results to guarantee an accurate diagnosis. Considering epidemiology, the case presented would have autoimmune myelitis as the main hypothesis.

 

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Artikel online veröffentlicht:
02. Oktober 2024