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.