Other Causes of Myelopathy, From Transverse Myelitis to Syringomyelia

Myelopathy can arise from demyelinating, vascular, inflammatory, infectious, neoplastic, metabolic, toxic, traumatic and congenital causes, including B12 or copper deficiency and nitrous oxide. Speed of onset helps narrow the list. Transverse myelitis develops over hours to 21 days with bilateral, often asymmetric signs and a clear sensory level, and needs emergency transfer. About 5 to 10% later develop MS. Spinal metastases most often come from breast, lung, kidney, prostate, thyroid and melanoma, and about 25% have no known cancer. Andy describes the severe night pain, unexplained weight loss and focal spinal tenderness to watch for, and the signs of metastatic cord compression, an oncological emergency. Spinal infection is suspected from exposure and immune risk factors, such as intravenous drug use, TB risk, diabetes or steroids, with severe progressive pain and focal tenderness. Arteriovenous malformations are rare and usually found incidentally. Syringomyelia, often linked to Chiari malformation, tends to affect sensation before motor function, as in a 21-year-old who lost temperature sense. MRI is the gold standard when myelopathy is suspected.