LONG SEGMENT >3 vertebral segments

INDEX

                                                                                

                                                                                                                         Short Segment Myelopathy                     MCQs on this topic   

TRIDENT

LOCATION
 

SAGITTAL T2

POST CONTRAST SAGGITAL

Other features 
 

Cervical/Thoracic
Single
Less often: multifocal1

Distribution similar to NMOSD6

Longitudinally extensive T2-hyperintense lesion  (in 80% 
of patients
2) involving the central cord (that would be
indistinguishable from an NMOSD lesion based on
T2-weighted images alone). 

These lesions tend to be relatively long: mean of 6
vertebral segments3.
Short, bulky tumour-like lesions are also described3.

Almost universal: intense, homogenous4, dorsal subpial5, that must
extend 2 or more vertebral segments.  This finding is significantly
more common in sarcoid myelopathy than in AQP4-IgG–positive
NMOSD myelitis6.  Ring enhancement is commoner in NMOSD.

Enhancement may persist for over 6 months, and take  years to resolve4.
Leptomeningeal enhancement may co-exist with dorsal subpial enhancement1.
Ventral subpial enhancement is also described3, frequently associated
with disc degeneration.
6

 

 Swelling
(non specific)    

         

 



From: Ref 1

 

 

 

 


 


AXIAL T2
 

POST CONTRAST

 

Axial trident5.

         
















                                               From: Ref 4

 


















                          From: Ref 1

 

 

 

 

 

References

1            Lopez Chiriboga S, Flanagan EP. Myelitis and Other Autoimmune Myelopathies. Contin Lifelong Learn Neurol 2021; 27: 62–92.

2            Sohn M, Culver DA, Judson MA, Scott TF, Tavee J, Nozaki K. Spinal cord neurosarcoidosis. Am J Med Sci 2014; 347: 195–8.

3            Murphy OC, Salazar-Camelo A, Jimenez JA, et al. Clinical and MRI phenotypes of sarcoidosis-associated myelopathy. Neurol Neuroimmunol neuroinflammation 2020; 7

4            Flanagan EP. Autoimmune myelopathies, 1st edn. Elsevier B.V., 2016 DOI:10.1016/B978-0-444-63432-0.00019-0.

5            Mustafa R, Passe TJ, Lopez-Chiriboga AS, et al. Utility of MRI Enhancement Pattern in Myelopathies With Longitudinally Extensive T2 Lesions. Neurol Clin Pract 2021; 11: E601–11.

6             Flanagan EP, Kaufmann TJ, Krecke KN, et al. Discriminating long myelitis of neuromyelitis optica from sarcoidosis. Ann Neurol 2016; 79: 437–47.