Both general neurologists and neurologists with a broad spectrum of subspecialty interests are often asked to evaluate patients with disorders of the spinal cord. Over the past decade, there have been significant advances in our understanding of a wide spectrum of immune-mediated, infectious, metabolic, hereditary, paraneoplastic, and compressive
myelopathies. Advances have been made in the classification and management of spinal
vascular malformations. Aortic reconstruction surgery has led to an increased incidence of spinal cord
stroke. It is important to recognize a
dural arteriovenous fistula as a cause of progressive
myelopathy. In the past, noninfectious
inflammatory myelopathies have frequently been categorized as idiopathic
transverse myelitis. Advances in neuroimaging and discovery of a serum antibody marker,
neuromyelitis optica-
immunoglobulin G (NMO-
IgG), have allowed more specific diagnoses, such as
multiple sclerosis and
neuromyelitis optica. Abnormalities suggestive of
demyelinating disease on brain magnetic resonance imaging (MRI) are known to be highly predictive of conversion to
multiple sclerosis in a patient who presents with a
transverse myelitis ("clinically isolated syndrome"). Acquired
copper deficiency can cause a clinical picture that mimics the
subacute combined degeneration seen with
vitamin B (12) deficiency. A history of
bariatric surgery is commonly noted in patients with
copper deficiency
myelopathy. Genetics has advanced our understanding of the complex field of hereditary
myelopathies. Three hereditary
myelopathy phenotypes are recognized: predominantly cerebellar (e.g.,
Friedreich's ataxia), predominantly motor (e.g., hereditary
spastic paraparesis), and a leukodystrophy phenotype (e.g.,
adrenomyeloneuropathy). Evaluation of
myelopathies when no abnormalities are seen on spinal cord imaging is a commonly encountered diagnostic challenge. This article presents some "clinical pearls" in the evaluation and management of
spinal cord diseases in context of these recent developments.