Venous hypertensive myelopathy as a potential mimic of transverse myelitis.
METHODS
Case report.


OBJECTIVE
We describe a patient who developed a myelopathy associated with a noncompressive herniated cervical intervertebral disc at the same level. We provide clinical and radiological evidence that reveals that even though the disc herniation did not compress the spinal cord, it diminished venous blood flow out of the spinal cord, possibly resulting in a venous hypertensive myelopathy (VHM).


METHODS
Baltimore, MD, USA.


METHODS
A 29-year-old woman developed a cervical radiculopathy, followed by a slowly progressive cervical myelopathy associated with a herniated C5-C6 disc. Magnetic resonance imaging showed a noncompressive disc herniation, a swollen spinal cord with increased T2 signal most prominent at the site of the herniated disc, extending several levels above and below the disc. The patient was diagnosed with acute transverse myelitis (ATM) and was started on IV steroids. However, unlike most cases of transverse myelitis, spinal fluid analysis was noninflammatory. In contrast, several features suggested that the patient instead had VHM. We suggest that the disc herniation resulted in impaired drainage of blood from the spinal cord through compression of the venous plexus near the intervertebral foramen.


METHODS
Although the patient did not recover function following high-dose steroid administration, she recovered completely following C5-C6 discectomy and fusion.


CONCLUSIONS
To our knowledge, this is the first report of likely VHM in the absence of a spinal arteriovenous malformation. We suggest that some patients diagnosed with ATM in the setting of extrinsic spinal column abnormalities may actually have a noninflammatory myelopathy associated with impaired spinal venous drainage.
Krishnan
C
C
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Malik
J M
JM
Kerr
D A
DA
D000208:Acute Disease; D000328:Adult; D016025:Bone Transplantation / Q000379:methods; D002574:Cervical Vertebrae; D003937:Diagnosis, Differential; D017586:Diskectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D009188:Myelitis, Transverse / Q000175:diagnosis*; D018570:Risk Assessment; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000601:surgery; D020758:Spinal Cord Vascular Diseases / Q000175:diagnosis* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D016896:Treatment Outcome