Table 1.
Clinical and paraclinical features of the main causes of inflammatory myelopathies.
| Onset | CSF | Brain MRI | Other | |
|---|---|---|---|---|
| Multiple sclerosis | Acute-Subacute/progressive | Frequent oligoclonal bands (>85%); (16) pleocytosis frequent but almost always <50/μL | Periventricular, cortical or juxtacortical and infratentorial lesions; central vein in more than 35–50% of brain white matter lesions (17, 18) | None |
| AQP4+NMOSD | Acute-Subacute/hyperacute | Rare oligoclonal bands (<20%); pleocytosis relatively frequent | Normal or non-specific; typical lesions can be found surrounding the 3rd and 4th ventricle (area postrema) corticospinal tract, and linear ependymal enhancement | Autoimmune comorbidities; strong female predominance |
| MOGAD | Acute-Subacute | Rare oligoclonal bands (<20%); pleocytosis frequent | Ill-defined borders, deep gray matter, white matter, middle cerebellar peduncles, large pons, corticospinal tract, cerebral cortical T2-hyperintensity, leptomeningeal enhancement | Recent vaccination or infection; children particularly predisposed |
| Anti-GFAP astrocytopathy | Acute-Subacute/progressive | Oligoclonal bands may be present (around 50%); pleocytosis frequent | Typical linear perivascular radial enhancement in the white matter perpendicular to lateral ventricles | Coexisting anti-NMDA-R and AQP4 antibodies; possible concomitant ovarian teratoma |
| Paraneoplastic myelopathies | Subacute/progressive | Oligoclonal bands may be present; pleocytosis frequent | Normal | Constitutional symptoms, weight loss, older age |
| Sarcoidosis | Subacute/progressive | Rare oligoclonal bands; pleocytosis extremely frequent | Basilar leptomeningeal enhancement, hydrocephalus, white matter enhancing lesions, involvement of pituitary gland, hypothalamus, and cavernous sinus | Systemic involvement (lungs, eyes, skin, heart) |
| Behçet's disease | Subacute/progressive | No oligoclonal bands; pleocytosis extremely frequent | Large lesions mainly located in the brainstem, internal capsule, and deep gray matter; possible pachymeningeal enhancement | Systemic involvement (oral, genital, skin, eyes) |
Only typical findings are reported.
AQP4+NMOSD, aquaporin-4 antibody positive neuromyelitis optica spectrum disorders; CSF, cerebrospinal fluid; GFAP, glial-fibrillary acidic protein; MOGAD, myelin oligodendrocyte glycoprotein antibody-associated disease; MRI, magnetic resonance imaging; NMDA-R, N-methyl-D-aspartate receptor.