case_images: PMC11823075_01
case_images: Depiction of the relative frequency (in %) and segment location of SACD in the present case series of seven patients (A). The median modified Rankin Scale (mRS) score at baseline (BL) was 3 (IQR: 3-4) and improved to 1 (IQR: 1-2) at follow-up (FU, p < 0.05). The FU period ranged from 3 months to 13.5 years. Created with BioRender.com
case_images: 42466_2024_364_Fig1_HTML.jpg
case_images: PMC11823075_01_42466_2024_364_Fig1_HTML.jpg
case_images: Fig1
case_images: T2-weighted sequences in the posterior columns of the cervical and thoracic spinal cord in all patients. Myelopathy signals extended over a median (range) of 5 (1-17) vertebral segments, spanning from C1 to T10, with predominant manifestation in the cervical spinal cord (Figs. 1A and 2). T2-weighted axial sequences revealed an 'inverted V sign', a typical lesion pattern of the posterior columns, in patients #1, #3, #4, #6, and #7 (Fig. 2). The median (IQR) mRS score improved from 3.0 (3.0-4.0) at baseline to 1.0 (1.0-2.0) at follow-up (p < 0.05, Wilcoxon matched-pairs signed-rank test; Fig. 1B).
case_images: Spinal MRIs of patient #1 - #7 revealed posterior column hyperintensity (white arrow) of the cervical and thoracic spinal cord in T2-weighted midsaggital and T2-weighted axial sections. The extension of the lesion is indicated for each patient, the maximum extension was from C1 to T10. Patient #1, #3, #4, #6 and #7 showed the characteristic "inverted V-sign" on axial sections (white arrow with black contours). Persisting hyperintensities on T2-weighted imaging in patient #1 on follow-up MRI assessment after 4 months. BL: baseline, FU: follow-up
case_images: 42466_2024_364_Fig2_HTML.jpg
case_images: PMC11823075_01_42466_2024_364_Fig2_HTML.jpg
case_images: Fig2
case_images: T2-weighted sequences in the posterior columns of the cervical and thoracic spinal cord in all patients. Myelopathy signals extended over a median (range) of 5 (1-17) vertebral segments, spanning from C1 to T10, with predominant manifestation in the cervical spinal cord (Figs. 1A and 2). T2-weighted axial sequences revealed an 'inverted V sign', a typical lesion pattern of the posterior columns, in patients #1, #3, #4, #6, and #7 (Fig. 2). Patient #1 underwent nerve conduction studies and an MRI of the cervical spine after 4 months, which showed worsening of the axonal polyneuropathy (data not shown) and overall unchanged T2 hyperintensities, despite clinical improvement (Fig. 2).