Article Text

Myelopathy: chameleons and mimics
  1. Lionel Ginsberg
  1. Department of Clinical Neurosciences, UCL Institute of Neurology, Royal Free Campus, University College London, London, UK
  1. Correspondence to Professor Lionel Ginsberg, Department of Neurology, Royal Free Hospital, Pond Street, London NW3 2QG, UK; Lionel.Ginsberg{at}


The diagnosis of spinal cord disease may be delayed or missed if the presentation does not conform to the expected pattern of a symmetrical spastic paraparesis with sphincter dysfunction and a sensory level. This may occur when a myelopathy has yet to evolve fully, or is highly asymmetrical, as in Brown-Séquard syndrome. Other potential distractions include fluctuating symptoms, as may accompany spinal cord demyelination, and pseudoneuropathic features, as seen acutely in spinal shock and in the chronic setting with some high cervical cord lesions. A second pathology, such as a polyneuropathy or polyradiculopathy, can mask the presence of a myelopathy. The converse situation, of non-myelopathic disease mimicking a cord lesion, arises typically when symptoms and/or signs approximate bilateral symmetry. This may happen with certain diseases of the brain, or of the peripheral nerves, with functional disorders and even occasionally with non-neurological disease. These sources of diagnostic difficulty assume clinical importance when they delay the recognition of conditions that require urgent treatment.


Statistics from


  • Disclaimer The case histories in this article are each amalgams of several patients and also include fictional elements, rather than being based on individuals, to preserve anonymity and to aid emphasis of specific points.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Ashwin Pinto, Southampton, UK.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.