PMC5742205_01
(A) Sagittal T2 sequence and (B) follow-up MRI a month later demonstrating signal abnormality within the cervical cord. The differential diagnosis of abnormal cord signal depends on the localization. Short segments are typical for multiple sclerosis, trauma, and progressive myelopathy, but long segment abnormalities represent a wider range of mostly uncommon conditions including transverse myelitis, neuromyelitis optica, dural arteriovenous fistula, arterial ischemia, sarcoidosis, vasculitis, West Nile virus, HIV, and Vitamin B deficiency.
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F1
A head MRI was unchanged and cervical spine MRI revealed a markedly abnormal signal (Figure 1).
Meningeal vessel showing intense transmural lymphocytic infiltrate with patent lumen.
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F2
More caudally, there was clear and unequivocal evidence of a meningovascular inflammatory process dominated by lymphocytes and involving both arteries and veins (Figure 2) but at this level spinal necrosis was not evident.
Anterior spinal artery cervical spinal cord showing evidence of prior occlusion in the form of proliferating medial myofibroblasts with recanalization [arrow].
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F3
There was also evidence of prior vascular occlusion involving the anterior spinal artery in at least two levels with revascularization (Figures 3 and 4).
Anterior spinal artery at a different cervical level again showing recanalization with multiple new channels [green arrows] with hemosiderin deposition [red arrow].
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F4
There was also evidence of prior vascular occlusion involving the anterior spinal artery in at least two levels with revascularization (Figures 3 and 4).