Non-neoplastic spinal cord lesions

Multiple sclerosis

This is a progressive neurodegenerative pathology characterized by the formation of multiple foci of inflammatory demyelination—plaques. Spinal cord involvement is extremely common.

Several types of MRI changes are distinguished:

• Focal lesions. On T2-weighted images (T2WI), wedge-shaped or oval hyperintense areas are visualized. They are predominantly located in the posterior and lateral columns. Unlike the brain, contrast enhancement is less common here. The spinal cord itself may be locally thickened due to edema, but its contours often remain unchanged.
• Diffuse changes. Observed in progressive forms of the disease. Signal abnormalities may extend over several segments, visually resembling the pattern of transverse myelitis.
• Atrophy. Most commonly affects the upper segments and directly correlates with the patient's clinical disability.

Special attention should be given to tumefactive multiple sclerosis. These are large lesions (greater than 2 cm) that clinically and radiologically mimic a neoplastic process. Despite their size, they exhibit minimal mass effect. A characteristic MRI sign is contrast enhancement in the form of an open-ring pattern (open-ring pattern), where the unclosed part points toward the gray matter. Administration of corticosteroids leads to a dramatic reduction in such lesions.

Acute disseminated encephalomyelitis (ADEM)

This condition represents an inflammatory demyelinating disorder of the central nervous system with a pronounced perivenous localization. Etiologically, ADEM is closely linked to an immune response: the process develops one to two weeks after a prior viral infection or vaccination.

The spinal cord is involved in approximately 30–40% of cases. Laboratory analysis of the cerebrospinal fluid (CSF) reveals elevated protein levels, and high titers of myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) are detected in blood serum in half of the patients.

Tomograms reveal hyperintense areas on sequences with a long TR. Contrast enhancement is absent or minimally pronounced. Intermittent, "skip" (skip) lesions are characteristic, although extensive segments may also occur. An important feature is that on follow-up imaging (follow-up), these changes typically resolve completely.

Acute transverse myelitis (ATM)

This is a heterogeneous syndrome with an acute or subacute onset, manifesting as sensory loss, muscle weakness, and autonomic dysfunction. The disease may be associated with infections or autoimmune processes, but often remains idiopathic. The prognosis ranges from full recovery to profound disability or death from respiratory failure.

The MRI presentation is characterized by spinal cord swelling and the presence of an extensive high-intensity intramedullary signal on T2WI. Contrast enhancement may be observed.

Depending on the extent of the process, the following are distinguished:

1. Longitudinally extensive transverse myelitis (LETM) — abnormalities involve more than 2 vertebral segments.
2. Acute partial transverse myelitis (APTM) — involvement is limited to an area of less than 2 segments.

Neuromyelitis optica (NMO)

Neuromyelitis optica, also known as Devic's disease, is an autoimmune antibody-mediated disorder. The pathogenesis is induced by specific autoantibodies against aquaporin-4 (NMO-IgG or AQP4-Ab), which serve as highly sensitive and specific markers of the pathology.

The disease occurs in all age groups, but women are significantly more susceptible. In 80% of cases, the condition takes a relapsing course. While it was previously thought that Devic's disease exclusively affects the optic nerves and spinal cord, frequent involvement of brain structures has now been proven.

Class and exam questions

What else to study on this topic

• Vascular diseases of the spinal cord
• Demyelinating polyneuropathies
• Developmental anomalies and cystic lesions
• Neurodegenerative and metabolic disorders

Other topics in the "Spine" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.