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Pearls: myelopathy.
[adrenomyeloneuropathy]
Both
general
neurologists
and
neurologists
with
a
broad
spectrum
of
subspecialty
interests
are
often
asked
to
evaluate
patients
with
disorders
of
the
spinal
cord
.
Over
the
past
decade
,
there
have
been
significant
advances
in
our
understanding
of
a
wide
spectrum
of
immune-mediated
,
infectious
,
metabolic
,
hereditary
,
paraneoplastic
,
and
compressive
myelopathies
.
Advances
have
been
made
in
the
classification
and
management
of
spinal
vascular
malformations
.
Aortic
reconstruction
surgery
has
led
to
an
increased
incidence
of
spinal
cord
stroke
.
It
is
important
to
recognize
a
dural
arteriovenous
fistula
as
a
cause
of
progressive
myelopathy
.
In
the
past
,
noninfectious
inflammatory
myelopathies
have
frequently
been
categorized
as
idiopathic
transverse
myelitis
.
Advances
in
neuroimaging
and
discovery
of
a
serum
antibody
marker
,
neuromyelitis
optica
-immunoglobulin
G
(
NMO-IgG
)
,
have
allowed
more
specific
diagnoses
,
such
as
multiple
sclerosis
and
neuromyelitis
optica
.
Abnormalities
suggestive
of
demyelinating
disease
on
brain
magnetic
resonance
imaging
(
MRI
)
are
known
to
be
highly
predictive
of
conversion
to
multiple
sclerosis
in
a
patient
who
presents
with
a
transverse
myelitis
(
"
clinically
isolated
syndrome
"
)
.
Acquired
copper
deficiency
can
cause
a
clinical
picture
that
mimics
the
subacute
combined
degeneration
seen
with
vitamin
B
(
12
)
deficiency
.
A
history
of
bariatric
surgery
is
commonly
noted
in
patients
with
copper
deficiency
myelopathy
.
Genetics
has
advanced
our
understanding
of
the
complex
field
of
hereditary
myelopathies
.
Three
hereditary
myelopathy
phenotypes
are
recognized
:
predominantly
cerebellar
(
e
.
g
.
,
Friedreich
's
ataxia
)
,
predominantly
motor
(
e
.
g
.
,
hereditary
spastic
paraparesis
)
,
and
a
leukodystrophy
phenotype
(
e
.
g
.
,
adrenomyeloneuropathy
)
.
Evaluation
of
myelopathies
when
no
abnormalities
are
seen
on
spinal
cord
imaging
is
a
commonly
encountered
diagnostic
challenge
.
This
article
presents
some
"
clinical
pearls
"
in
the
evaluation
and
management
of
spinal
cord
diseases
in
context
of
these
recent
developments
.
Diseases
Validation
Diseases presenting
"leukodystrophy"
symptom
achondroplasia
adrenomyeloneuropathy
alexander disease
cadasil
canavan disease
carcinoma of the gallbladder
classical phenylketonuria
coats disease
fabry disease
gm1 gangliosidosis
krabbe disease
neonatal adrenoleukodystrophy
phenylketonuria
pyruvate dehydrogenase deficiency
wiskott-aldrich syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated