Zalewski et al listed conditions that need to be excluded when considering the diagnosis of spontaneous spinal cord infarction. The authors are from the Mayo Clinic.
Presentation: an acute nontraumatic myelopathy with:
(1) rapid progression over 12 hours or less (time between onset and nadir). There may be a stuttering course beforehand, but any sudden deterioration should be rapid.
(2) show severe acute motor and/or sensory deficits. There is usually the loss of antigravity strength. Sensory loss may be disabling.
Intramedullary nonprocedural causes of acute myelopathy:
(1) toxic (nitrous oxide, heroin)
(2) neoplasm (metastatic; tumor hemorrhage)
(3) vascular (hematomyelia; spinal dural arteriovenous fistula; vasculitis)
(4) infectious or post-infectious (HIV, syphilis, Lyme disease, viral myelitis; acute flaccid myelitis)
(5) inflammatory (multiple sclerosis; sarcoidosis; myelin oligodendrocyte glycoprotein (MOG)-IgG demyelinating disease; aquaporin-4 (AQP4)-IgG seropositive neuromyelitis optica spectrum disorder; idiopathic transverse myelitis)
(6) spontaneous spinal cord infarction
Extramedullary nonprocedural causes of acute myelopathy:
(1) epidural hematoma
(2) metastatic epidural compression
(3) epidural abscess
(4) severe spondylosis with minor trauma
Periprocedural acute myelopathy:
(1) epidural hematoma
(2) severe spondylosis
(3) periprocedural spinal cord infarction
