Table 4

Investigation of myelopathy

InvestigationPurpose/diagnosis
Commonly performed
 Spinal MRIDetect compression, identify intrinsic lesions, abnormal vessels
 Brain MRIEvidence of demyelination, leukodystrophy*
 Chest x-rayOccult neoplasm, sarcoid
 EMG/nerve conductionEvidence of lower motor neuron involvement to support a diagnosis of amyotrophic lateral sclerosis, evidence of a coexistent neuropathy
 CSF (cells, protein, oligoclonal bands, culture, PCR)Evidence of inflammation, infection
 Visual evoked potentialsCoexistent optic nerve involvement
 Routine haematology and biochemistry including vitamin B12Subacute combined degeneration, other metabolic causes
 Serology including autoimmune panel, evidence of specific infectionsAutoimmune connective tissue disorders, specific infections (HIV, syphilis)
Less commonly used, selected patients only
 HTLV-1 serologyTropical spastic paraparesis
 Aquaporin-4 antibodiesNeuromyelitis optica
 Antineuronal antibodiesParaneoplastic myelopathy
 Very long chain fatty acidsAdrenomyeloneuropathy
 Serum copper/caeruloplasminCopper deficiency myeloneuropathy
 Blood culturesCausative organism of epidural abscess, suspicion of infective endocarditis
 Mutation analysisFor example, for hereditary spastic paraplegia genetics
 AngiographyDural arteriovenous fistula, arteriovenous malformation
  • * Brain imaging may serve additional purposes, such as revealing focal atrophy of the precentral gyrus, supporting a diagnosis of primary lateral sclerosis or occasionally leading to the discovery of a parasagittal meningioma, masquerading as a myelopathy by causing a spastic paraparesis, albeit asymmetrical.