MRI with neck extension to diagnose cervical spondylotic myelopathy

A 70-year-old woman was diagnosed with idiopathic transverse myelitis. Her symptoms had begun with hand (ulnar distribution) and feet numbness, followed by progressive lower limb weakness and reverse Lhermitte’s phenomenon (neck extension provoking electrical sensations radiating to the spine and limbs) worsening over 2 months. Initial MR scan of cervical spine showed a T2-hyperintense lesion from C5–C7 (figure 1A,B) with a transverse band of enhancement at C5–C6 (figure 2A,B). MR scans of brain, thoracic and lumbar spine were essentially normal. She had negative aquaporin-4 antibody, rapid plasma reagin, HIV, antinuclear antibody, SSA/anti-Ro and SSB/anti-La antibodies and normal serum vitamin B12 and methylmalonic acid. Lumbar puncture was not performed. After an initial diagnosis of idiopathic transverse myelitis, she was referred to our unit 7 months after symptom onset. By then she required help to walk at home and was using a wheelchair for longer distances. Figure 1 MR scan of cervical spine (sagittal and axial T2-weighted images) 2 months after symptom onset with the neck in the neutral position (A, B); 4 months after onset with the …