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A practical approach to the diagnosis of spinal cord lesions
  1. Romina Mariano1,
  2. Eoin P Flanagan2,
  3. Brain G Weinshenker2,
  4. Jacqueline Palace1
  1. 1Nuffield Department of Clinical Neuroscience, Oxford University, Oxford, UK
  2. 2Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Jacqueline Palace, Department of Neurology, John Radcliffe Hospital, Oxford OX3 9DU, UK; jacqueline.palace{at}


Every neurologist will be familiar with the patient with atypical spinal cord disease and the challenges of taking the diagnosis forward. This is predominantly because of the limited range of possible clinical and investigation findings making most individual features non-specific. The difficulty in obtaining a tissue diagnosis further contributes and patients are often treated empirically based on local prevalence and potential for reversibility. This article focuses on improving the diagnosis of adult non-traumatic, non-compressive spinal cord disorders. It is structured to start with the clinical presentation in order to be of practical use to the clinician. We aim, by combining the onset phenotype with the subsequent course, along with imaging and laboratory features, to improve the diagnostic process.

  • myelopathy
  • MRI
  • clinical neurology

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  • Contributors RM and JP conceived the review and all authors were involved in the writing of the paper.

  • Funding RM is undertaking graduate studies funded by The Rhodes Trust.

  • Competing interests JP: Funding for highly specialised services to run a national congenital myasthenia service and a neuromyelitis service. Support for scientific meetings and honorariums for advisory work from Merck Serono, Biogen Idec, Novartis, Teva, Abide, Chugai Pharma, Alexion, MedDay, Argenx and Bayer Schering, Medimmune and unrestricted grants from Merck Serono, Novartis, Biogen Idec, Chugai, Alexion and Bayer Schering. MS society and Guthie Jackson Foundation research grants. RM is undertaking graduate studies funded by The Rhodes Trust. BGW receives royalties from RSR, Oxford University, Hospices Civil de Lyon, and MVZ Labor PD Dr Volkmann und Kollegen GbR for a patent of NMO-IgG as a diagnostic test for NMO and related disorders. He serves as a member of an adjudication committee for clinical trials in NMO being conducted by MedImmune and Alexion pharmaceutical companies. He is a consultant for Caladrius Biosciences and Brainstorm Therapeutics regarding potential clinical trials for NMO. He serves as a member of a data safety monitoring committee for clinical trials conducted by Novartis.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Lionel Ginsberg, London, UK.

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