Discussion:
Myelopathy, encompassing traumatic, vascular, neoplastic, neuropathic, infectious, and any other insult to the spinal cord, remains a clinical diagnosis, with specific neurological symptoms and signs that help localize the insult to the spinal cord. Classical upper and lower motor neuron signs are prominent depending on the level of insult. Our patient, having cervical myelopathy, had Upper Motor Neuron (UMN) signs and symptoms in both upper and lower extremities and bladder involvement. Furthermore, a “sensory level” with a band-like sensation at the superior margin is expected in thoracic and lumbar myelopathies. However, this was absent in our patient. Hoffman’s sign was positive, corroborating its frequent association with cervical myelopathy The differential diagnosis consists of metabolic, neoplastic, vascular, infectious, and demyelinating conditions. The absence of fever and specific interpretation of imaging findings, including the pattern of enhancement and other features, helps to narrow the differentials. Other causes of myelopathy were also investigated and ruled out.4
Regarding imaging findings, pancake enhancement of the cervical spine was first reported in 2014 by Flanagan et al., who reported a similar case of upper extremity weakness and paresthesias.Since then, it has been acknowledged as an important, albeit rare, finding of compressive spondylotic myelopathy. The pancake-like enhancement of the spinal cord on sagittal imaging and circumferential short segment enhancement in the axial plane is quite distinctive. Its key importance lies in aiding with the distinction between compressive myelopathy and other conditions causing medullary enhancement, including inflammatory myelopathy and intramedullary tumors, which, in the absence of hallmark radiological findings, are often challenging.