Analysis of clinical and imaging features of ischemic myelopathy
Objective To summarize the clinical and imaging features of patients with ischemic myelopathy. Methods A total of five patients who were misdiagnosed as acute myelitis and finally diagnosed as ischemic myelopathy in Xuanwu Hospital of Capital Medical University from 2015 to 2023 were selected. The clinical data of the patients were analyzed retrospectively,and the clinical symptoms and imaging features were analyzed. Results Among the five patients,there were two males and three females,with median onset age of 59 years old. All of the patients had an acute onset of spinal cord damage such as weakness and numbness of the limbs. Spinal cord MRI showed abnormal intramedullary signals in five patients,including cervical myelopathy in four cases and lumbar bulging lesion in one case. Axial images showed typical "snake-eye sign" in five cases,and sagittal images showed "pencil sign" in two cases. The patients was treated with immunotherapy but leading to poor results. Anticoagulation or antiplatelet drugs and rehabilitation of spinal cord function was given after the definite diagnosis,and the symptoms improved to varying degrees,but all had left symptoms of limb weakness or numbness due to delayed treatment. Conclusions The special signs of spinal MRI,namely 'snake eye sign' and 'pencil sign',can be used as the important imaging features to differentiate ischaemic myelopathy from acute myelitis. Physicians should improve the recognition of such images in patients with acute onset of spinal cord damage.
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