Objectives: Spinal cord compression may be associated with a fusiform cord lesion on T2-weighted magnetic resonance imaging (MRI) images, leading to confusion with transverse myelitis and delaying effective surgical treatment.
Results: We describe 5 patients referred for evaluation of suspected neuromyelitis optica in whom the final diagnosis was symptomatic cervical spinal stenosis. The patients had gradually progressive myelopathy, with symptoms progressing over an average of 34.4 weeks. Although cervical spinal cord MRI identified long T2 hyperintense lesions, gadolinium enhancement was localized to the level of maximum spinal cord compression, in contrast to the much more extensive distribution of gadolinium enhancement characteristic of myelitis. Compressive myelopathy symptoms responded poorly to corticosteroids, but responded well to surgical decompression.
Conclusion: Cervical cord compression due to spinal stenosis may lead to long intramedullary fusiform T2 hyperintensity on MRI, mimicking inflammatory myelopathy, but the diagnoses can be accurately distinguished by a combination of clinical and radiologic characteristics.