A radiation field that involves the spinal cord may be associated with a myelopathy years later.
Clinical findings:
(1) bilateral sensory deficit, motor weakness and/or autonomic dysfunction
(2) a history of radiation therapy with the field involving the spinal cord. The history of radiation therapy may be 10-15 years prior to onset of symptoms.
(3) exclusion of other causes of a transverse myelitis
Electromyography (EMG) may show myokymia (involuntary, spontaneous, localized quivering of muscle fibers).
Acute radiation injury can result in swelling and enhancement of the cord on image studies. As time passes the cord may show atrophy on imaging scans.
The adjacent vertebral body may show radiation injury. It may appear hyperintense on a T2-weighted imaging study.
Differential diagnosis may include:
(1) ischemic cord syndromes
(2) paraneoplastic cord syndromes
(3) infection
(4) tumor metastases
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