title: Adult-onset spastic paraparesis: an approach to diagnostic work-up.
abstract: Adult-onset, chronic progressive spastic paraparesis may be due to a large number of causes and poses a diagnostic challenge. There are no recent evidence-based guidelines or comprehensive reviews to help guide diagnostic work-up. We survey the literature on chronic progressive spastic paraparesis, with special emphasis on myelopathies, and propose a practical, MRI-based approach to facilitate the diagnostic process. Building on neuro-anatomic and radiographic conventions, we classify spinal MRI findings into six patterns: extradural; intradural/extramedullary; Intramedullary; Intramedullary-Tract specific; Spinal Cord Atrophy; and Normal Appearing Spinal Cord. A comprehensive differential diagnosis of chronic progressive myelopathy for each of the six patterns is generated. We highlight some of the more common and/or treatable causes of progressive spastic paraparesis and provide clinical pointers that may assist clinicians in arriving at the diagnosis. We outline a practical, comprehensive MRI-based algorithm to diagnosing adult-onset chronic progressive myelopathy.
authors.affiliation: NYU Langone Multiple Sclerosis Comprehensive Care Center, New York, NY, USA. Electronic address: lana.zhovtisryerson@nyumc.org.
authors.forename: Lana
authors.initials: L
authors.lastname: Zhovtis Ryerson
authors.affiliation: NYU Langone Multiple Sclerosis Comprehensive Care Center, New York, NY, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Herbert
authors.affiliation: NYU Langone Multiple Sclerosis Comprehensive Care Center, New York, NY, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Howard
authors.affiliation: NYU Langone Multiple Sclerosis Comprehensive Care Center, New York, NY, USA.
authors.forename: Ilya
authors.initials: I
authors.lastname: Kister
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D020336:Paraparesis, Spastic / Q000175:diagnosis* / Q000209:etiology*; D013118:Spinal Cord Diseases / Q000150:complications*
keywords: Chronic; Diagnostic evaluation; Differential diagnosis; Magnetic resonance imaging; Spastic paraparesis; myelopathy