C130 - Diagnostic Pearls in Myelitis: a Case-based Approach

Event Time: Tuesday May 7, 2019 7:00 am to 9:00 am
Topic(s): MS and CNS Inflammatory Disease
Director(s): Eoin Flanagan MBBCh
Description: Getting the diagnosis right is critical in those with spinal cord disease as morbidity from spinal cord disease is often severe, can develop quickly, and is frequently irreversible. Failure to quickly identify the cause and institute the correct treatment may result in irreversible paraplegia. The increasing number of specific causes of myelopathy/myelitis identified over the last two decades has made evaluation of such patients more challenging. Two recent studies published in Neurology (Zalewski et al, Neurology 2018; Barreras et al, Neurology 2018) highlighted that large proportions of patients referred with idiopathic transverse myelitis actually had a specific cause identified for their myelopathy. This shows that the causes of myelitis and its mimics are poorly recognized among neurologists and that a knowledge gap exists. One of the best ways to address this knowledge gap is to teach by cases that highlight clinical, laboratory, and neuroimaging pearls and pitfalls that are commonly encountered. It is difficult for general neurologists or specialists to keep abreast of such advances across multiple subspecialties including autoimmune (myelin oligodendrocyte glycoprotein autoantibody and aquaporin-4-IgG associated myelitis), inflammatory (neurosarcoid), infectious/post infectious (enterovirus D68 associated acute flaccid paralysis), to name just a few examples. The focus of this course will be a case-based approach to myelopathy for all neurologists with a focus on clues to help get the diagnosis right in a patient with acute, subacute, or chronic inflammatory/autoimmune myelopathies and their mimics. Through each case example common pitfalls in diagnosis (e.g., the presence of gadolinium enhancement in non-inflammatory myelopathies) will be addressed. There will be a major focus on clinical pearls (time to nadir) and radiology pearls (MRI patterns that can help suggest the underlying cause).
Completion Message: Participants will recognize the critical importance of time to nadir in the evaluation of myelopathy. Laboratory testing will be emphasized including when to order neural autoantibodies (e.g., Aquaporin-4-IgG or Myelin-Oligodendrocyte-Glycoprotein-IgG), how to interpret cerebrospinal fluid testing, and how to recognize MRI patterns (length of lesion, gadolinium enhancement pattern) that can guide clinicians to the correct diagnosis. Finally, participants will understand the benefits (steroids and if needed PLEX in acute transverse myelitis) and pitfalls of treatments for myelopathy (empiric steroids can worsen dural arteriovenous fistula).
CME Credits: 2
Core Competencies: Patient Care, Medical Knowledge

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