Dr Carlo Pardo Grand Rounds: Myelitis and Myelopathies, Part 2

A special two-part Grand Rounds presentation by Dr. Carlo Pardo, who is a clinical neurologist/pathologist and professor of neurology and pathology at the Johns Hopkins School of Medicine. Part One He began by stating that the main objective of this presentation is understanding the concept of myelopathies versus myelitis. He wants to present a diagnostic approach for the evaluation of a patient with an acute case of myelopathy and vascular myelopathy, and review the current concepts of vascular myelopathies, something that probably will be encountered very often in rehabilitation clinical practice. It is truly important that after this lecture to stop using the term myelitis and instead use a more precise etiological diagnosis of myelopathy. He disclosed where his research funding comes from. He presented a historical concept of myelitis and myelopathies. In the past several years, the major revolution in neurology has been the discovery of many biomarkers that are identified myelopathies. Etiological diagnosis should dominate the evaluation of patients with acute myelopathies because once we identify the etiological factor, we are able to help those patients in a better way. A lack of proper characterization may lead to mistreatment. A major difficulty in assessment of non-inflammatory myelopathy is at this moment, we do not have clear criteria to diagnose some of them. So keep in mind that the temporal assessment of the lesion by MRI is also important and you need to think about the timing of the MRI when you are preparing to give an interpretation to decide what is a potential etiological diagnosis. Part Two Getting the clinical information, the temporal profile of the patient, along with MRI findings and spinal fluid analysis is important during the analysis of patients presenting with myelopathic syndromes. MRI is one important tool and a very good way to establish the magnitude and localization of spinal cord lesions. One thing he likes to emphasize also is that the presence of myelopathies are not following the classical territories that we know. One thing that is important is that in addition to the blood supply is the blood drainage. The blood drainage of the spinal cord once again is very complex and there is a good and complex pattern of drainage at every segment of the spinal cord. He emphasized for individuals working in rehabilitation that there are other areas of the blood supply that may be affected. Some examples were provided of what he meant. He discussed experiences in their analysis of some cases at his institution where they analyzed 125 patients, attempting to classify the topographic distribution of the lesion.