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

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