The clinical diagnosis of myelopathy.

Myelopathy is a complex diagnostic problem with many possible causes. Diagnosis rests on recognition of a constellation of symptoms consistent with central nervous system pathology involving trunk, arms, and legs and, in general, sparing the head. Symptoms of cerebral and neuromuscular disease may mimic myelopathy and require brain imaging or electromyography. Pain, most commonly over the site of the lesion, is one of the cardinal complaints of patients with spinal cord disease. Complaints of motor abnormalities caused by myelopathy may include sudden weakness and paralysis, clumsiness, fatigability; sensory complaints such as paresthesias, numbness, deadness, dysesthesias, and bladder symptoms are also characteristic. General examination may point to systemic disease associated with myelopathy. Neurological examination excludes cerebral disease. Motor and sensory examination may define the level of the lesion. Physical examination localizes not only the level of the spinal cord lesion but the anatomic distribution of the lesion within a given level. When tumor or paraspinal infection are diagnostic possibilities, emergent imaging of the spine is required.