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Case Reports in Neurological Medicine
Volume 2016, Article ID 4125294, 9 pages
Case Report

A 66-Year-Old Woman with a Progressive, Longitudinally Extensive, Tract Specific, Myelopathy

1Department of Neurology, Division of Physical Medicine and Rehabilitation, Washington University School of Medicine, Campus Box 8518, 4444 Forest Park Blvd., St. Louis, MO 63108, USA
2Department of Pathology & Immunology, Division of Neuropathology, Saint Louis University School of Medicine, 1402 South Grand Blvd., Saint Louis, MO 63104, USA
3Department of Radiology, Wake Radiology, 3949 Browning Place, Raleigh, NC 2760, USA
4Department of Pathology & Immunology, Division of Neuropathology, Washington University School of Medicine, Campus Box 8118, 660 S. Euclid Ave., St. Louis, MO 63110, USA
5Department of Neurology, Divisions of Neuromuscular and General Neurology, Washington University School of Medicine, Campus Box 8111, 660 S. Euclid Ave., St. Louis, MO 63110, USA

Received 5 August 2016; Revised 19 October 2016; Accepted 25 October 2016

Academic Editor: Peter Berlit

Copyright © 2016 Elizabeth O’Keefe et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A 66-year-old woman presented with progressive lancinating pain and sensory deficits attributable to a myelopathy of unclear etiology. Spinal cord magnetic resonance imaging showed a longitudinally extensive T2-hyperintense lesion of the dorsal columns. Comprehensive serum, urine, and cerebrospinal fluid analyses failed to identify an etiology. Empiric intravenous methylprednisolone and intravenous immunoglobulin were of no benefit and serial screens for an occult malignancy were negative. She developed dysesthesias and allodynia affecting her entire body and lost the use of her arms and legs due to severe sensory ataxia that was steadily progressive from onset. She opted against additional aggressive medical management of her condition and passed away on hospice eleven months after symptom onset. Autopsy revealed findings most consistent with polyphasic spinal cord ischemia affecting the dorsal and lateral white matter tracts and, to a lesser extent, adjacent gray matter. The underlying etiology for the progressive vasculopathy remains unknown. Spinal cord ischemia affecting the posterior spinal cord is rare and to our knowledge this case represents the only instance of a progressive spinal cord tractopathy attributable to chronic spinal cord ischemia.