Beyond Transverse Myelitis: Neuroradiology’s Role in Identifying Spinal Cord Infarction

Rethinking Myelitis: Neuroradiology in Spinal Cord Infarction

Abstract

Spinal cord infarction is a rare but serious condition often misdiagnosed as transverse myelitis due to overlapping clinical and imaging features. Differentiating vascular from inflammatory etiologies is critical for proper management. Neuroradiology plays a key role, with MRI being the main diagnostic tool. Common causes include aortic disease, fibrocartilaginous embolism, and idiopathic cases. We report the case of a 53-year-old man with a history of hypertension and obesity who presented with progressive lower back pain, acute worsening, right lower extremity numbness, and urinary retention. MRI revealed acute spinal cord infarction with adjacent vertebral body involvement, supporting a vascular etiology. Transverse myelitis was initially suspected but ruled out after neuroradiologic assessment. The patient was treated with corticosteroids, aspirin, statins, and analgesics. He showed clinical and functional improvement with physical therapy, despite initial limitations due to pain. This case highlights the importance of early imaging, the role of neuroradiology in the etiologic definition of acute myelopathies, and the need to improve access to early rehabilitation to optimize functional outcomes.