Traversing the Not-Always-Transverse Myelopathies

STEVEN L. LEWIS, MD, FAAN Spinal Cord Disorders p. 10-11 February 2021, Vol.27, No.1 doi: 10.1212/01.CON.0000733580.25753.bd
EDITOR’S PREFACE
BROWSE ARTICLES

EDITOR-IN-CHIEF

This issue of Continuum is devoted to the diagnosis and management of diseases that affect the spinal cord or the cauda equina, disorders that can lead to profound disability but can often be ameliorated or reversed with expeditious diagnosis and appropriate therapy. I am so appreciative of Dr Eoin P. Flanagan for his skillful guest editorship, including his enlistment of outstanding content-expert authors and his meticulousness throughout all phases of the issue’s development.

I am so appreciative of Dr Eoin P. Flanagan for his skillful guest editorship, including his enlistment of outstanding content-expert authors and his meticulousness throughout all phases of the issue’s development.

The issue begins with the article by Dr Todd A. Hardy, who provides a detailed review of anatomy and localization of the spinal cord, conus medullaris, and cauda equina, basic neuroanatomic principles that are key to our clinical assessment of disorders affecting any of these regions. In the next article, Dr Nicholas L. Zalewski discusses the diagnosis and management of vascular disorders that cause spinal cord dysfunction, such as from infarction, venous congestion, or hemorrhage.

Drs Sebastian Lopez Chiriboga and Flanagan next discuss the rapidly evolving concepts regarding disorders that cause inflammation of the spinal cord (myelitis), including aquaporin-4-IgG–seropositive neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein (MOG)-IgG–associated disease, multiple sclerosis, paraneoplastic myelopathies, and other autoimmune myelitides, syndromes that are often not fully “transverse” in cross-sectional spinal cord involvement despite the commonly associated adjective. In the following article, Dr Michel Toledano discusses the many disorders of the spinal cord and cauda equina that can occur because of infections. Dr Amy A. Pruitt then provides a thorough review of the diagnosis and current management of the myelopathies that are caused by primary or metastatic neoplasms affecting the spinal cord.

Dr Natalie Elizabeth Parks next reviews the many myelopathies that can occur because of metabolic and toxic disorders affecting the spinal cord, entities so important to consider in our differential diagnosis of progressive, and potentially reversible, spinal cord dysfunction. In the next article, Dr Shamik Bhattacharyya reviews the numerous structural spine disorders that can result in spinal cord dysfunction and for which neurologists are key in helping assess the role of neurosurgical consultation and intervention. Dr John K. Fink then reviews and updates us on the various hereditary disorders whose manifestations include, but are often not limited to, spinal cord dysfunction.

Leaving the spinal cord, literally and figuratively, the next article by Dr Samantha LoRusso discusses the disorders that can affect the cauda equina, whether from compression (a neurosurgical emergency) or one of the myriad other potential causes of cauda equina dysfunction.

In the final review article of the issue, Drs Felix E. Diehn and Karl N. Krecke provide an encyclopedic review of neuroimaging clues to the diagnosis of the multitude of disorders that can affect the spinal cord and cauda equina, with many instructive representative images.

After reading the issue and taking the Postreading Self-Assessment and CME Test written by Drs Douglas J. Gelb and Allyson R. Zazulia, readers may earn up to 20 AMA PRA Category 1 CreditsTM toward self-assessment CME or, for Canadian participants, a maximum of 20 hours toward the Self-Assessment Program (Section 3) of the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. Additional credit can be obtained by listening to Continuum Audio interviews associated with this and other Continuum issues, available to all subscribers, and completing tests on the Continuum Audio web platform or mobile app. Continuum Audio is also accredited by the Royal College of Physicians and Surgeons of Canada.

This issue, as well as the October and December 2020 issues, are part of a pilot program of Continuum issues read aloud. Different from Continuum Audio, these are recordings read verbatim from the print articles by Dr Michael Kentris, a neurologist at the Clinical Neuroscience Institute in Dayton, Ohio. The audio files are available to all Continuum subscribers in the AAN’s Online Learning Center at continpub.com/CME. I encourage you to listen and submit the survey with your feedback on this pilot.

My sincerest thanks to Dr Flanagan for his remarkable guest editorship of this issue and for his hands-on devotion to creating such a well-organized and well-illustrated (with representative neuroimages) volume to help us navigate the complexities of the many patients who present with dysfunction of the spinal cord or cauda equina.

—STEVEN L. LEWIS, MD, FAAN
EDITOR-IN-CHIEF

© 2021 American Academy of Neurology.