title: A 66-Year-Old Woman with a Progressive, Longitudinally Extensive, Tract Specific, Myelopathy.
abstract: A 66-year-old woman presented with progressive lancinating pain and sensory deficits attributable to a myelopathy of unclear etiology. Spinal cord magnetic resonance imaging showed a longitudinally extensive T2-hyperintense lesion of the dorsal columns. Comprehensive serum, urine, and cerebrospinal fluid analyses failed to identify an etiology. Empiric intravenous methylprednisolone and intravenous immunoglobulin were of no benefit and serial screens for an occult malignancy were negative. She developed dysesthesias and allodynia affecting her entire body and lost the use of her arms and legs due to severe sensory ataxia that was steadily progressive from onset. She opted against additional aggressive medical management of her condition and passed away on hospice eleven months after symptom onset. Autopsy revealed findings most consistent with polyphasic spinal cord ischemia affecting the dorsal and lateral white matter tracts and, to a lesser extent, adjacent gray matter. The underlying etiology for the progressive vasculopathy remains unknown. Spinal cord ischemia affecting the posterior spinal cord is rare and to our knowledge this case represents the only instance of a progressive spinal cord tractopathy attributable to chronic spinal cord ischemia.
authors.affiliation: Department of Neurology, Division of Physical Medicine and Rehabilitation, Washington University School of Medicine, Campus Box 8518, 4444 Forest Park Blvd., St. Louis, MO 63108, USA.
authors.forename: Elizabeth
authors.identifier: 0000-0002-0335-8513
authors.initials: E
authors.lastname: O'Keefe
authors.affiliation: Department of Pathology & Immunology, Division of Neuropathology, Saint Louis University School of Medicine, 1402 South Grand Blvd., Saint Louis, MO 63104, USA.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Schwetye
authors.affiliation: Department of Radiology, Wake Radiology, 3949 Browning Place, Raleigh, NC 2760, USA.
authors.forename: John
authors.identifier: 0000-0003-2427-1764
authors.initials: J
authors.lastname: Nazarian
authors.affiliation: Department of Pathology & Immunology, Division of Neuropathology, Washington University School of Medicine, Campus Box 8118, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Perrin
authors.affiliation: Department of Pathology & Immunology, Division of Neuropathology, Washington University School of Medicine, Campus Box 8118, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schmidt
authors.affiliation: Department of Neurology, Divisions of Neuromuscular and General Neurology, Washington University School of Medicine, Campus Box 8111, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
authors.forename: Robert
authors.identifier: 0000-0002-0063-8640
authors.initials: R
authors.lastname: Bucelli