therapeuticЮжно-Российский журнал терапевтической практикиSouth Russian Journal of Therapeutic Practice2712-81563033-8344РостГМУ10.21886/2712-8156-2025-6-2-118-128therapeutic-648Research ArticleЛЕКЦИИLECTURESОсобенности дифференциальной диагностики воспалительных и невоспалительных миелопатийPeculiarities of differential diagnostics of inflammatory and noninflammatory myelopathieshttps://orcid.org/0000-0002-9185-4073СорокинЮ. Н.SorokinYu. N.

Сорокин Юрий Николаевич, д.м.н., доцент; профессор кафедры неврологии и восстановительной медицины с курсом остеопатии

Ростов-на-Дону

Yuri N. Sorokin

Rostov-on-Don

sorokin.yuri@bk.ruСорокинаЕ. Ю.SorokinaE. Yu.

Сорокина Елена Юрьевна, старший преподаватель кафедры иностранных языков с курсом латинского языка

Ростов-на-Дону

Elena Yu. Sorokina

Rostov-on-Don

lenoklug@mail.ruФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава РоссииРоссияFSBEI of HE “Rostov State Medical University” of the Ministry of Health of RussiaRussian Federation20251207202562118128Copyright © Сорокин Ю.Н., Сорокина Е.Ю., 20252025Сорокин Ю.Н., Сорокина Е.Ю.Sorokin Y.N., Sorokina E.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therapeutic-j.ru/jour/article/view/648

Несмотря на гетерогенную этиологию миелопатий и стереотипность основных клинических проявлений поражений спинного мозга, патогномоничные клинические особенности, признаки вовлечения экстраспинальных структур, особенности течения патологического процесса, различия представления очагов поражения на сагиттальных и аксиальных магнитно-резонансных изображениях и данные лабораторной диагностики позволяют проводить дифференциальную диагностику как между воспалительными и невоспалительными формами, так и внутри самих этих групп.

Despite the heterogeneous etiology of myelopathies and the stereotyping of the main clinical manifestations of spinal cord lesions, pathognomonic clinical features, signs of involvement of extraspinal structures, features of the course of the pathological process, differences in the presentation of lesions on sagittal and axial magnetic resonance images and laboratory diagnostic data allow differential diagnosis between both inflammatory and non-inflammatory forms, and within these groups themselves.

рассеянный склерозрасстройства спектра оптиконейромиелитамиелитмиелопатиямагнитно-резонансная томографияmultiple sclerosisneuromyelitis optica spectrum disordermyelitismyelopathymagnetic resonance imagingReferencesSechi E., Flanagan E.P. Evaluation and Management of Acute Myelopathy. Semin. Neurol. 2021; 41(05):511-529. https://doi.org/10.1055/s-0041-1733792Sechi E., Flanagan E.P. Evaluation and Management of Acute Myelopathy. Semin. Neurol. 2021; 41(05):511-529. https://doi.org/10.1055/s-0041-1733792Pardo C.A. Clinical Approach to Myelopathy Diagnosis. Continuum (Minneap Minn). 2024;30(1):14-52. https://doi.org/10.1212/CON.0000000000001390Pardo C.A. Clinical Approach to Myelopathy Diagnosis. Continuum (Minneap Minn). 2024;30(1):14-52. https://doi.org/10.1212/CON.0000000000001390Valencia-Sanchez К., Flanagan E.P. Uncommon inflammatory/immunerelated myelopathies. J. of Neuroimmunology. 2021;361:577750. https://doi.org/10.1016/j.jneuroim.2021.577750Valencia-Sanchez К., Flanagan E.P. Uncommon inflammatory/immunerelated myelopathies. J. of Neuroimmunology. 2021;361:577750. https://doi.org/10.1016/j.jneuroim.2021.577750Jarius S., Aktas O., Ayzenberg I., Bellmann-Strobl J., Berthele A., Giglhuber K. et al. Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis. J. Neurol. 2023;270:3341-3368. https://doi.org/10.1007/s00415-023-11634-0Jarius S., Aktas O., Ayzenberg I., Bellmann-Strobl J., Berthele A., Giglhuber K. et al. Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) – revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis. J. Neurol. 2023;270:3341-3368. https://doi.org/10.1007/s00415-023-11634-0Евтушенко С.К., Скоромец А.А., Скоромец А.П., Евтушенко О.С. Избранные лекции по детской и общей неврологии. М.: Медицинское информационное агентство; 2021.Yevtushenko S.K., Skoromets А.А., Skoromets А.Р., Yevtushenko О.S. Selected Lectures on Pediatric and General Neurology. Мoscow: Meditsinskoe informatsionnoe agentstvo; 2021. (In Russ.)Cacciaguerra L., Flanagan E.P. Updates in NMOSD and MOGAD Diagnosis and Treatment: A Tale of Two Central Nervous System Autoimmune Inflammatory Disorders. Neurologic Clinics. 2024;42(1):77-114. https://doi.org/10.1016/j.ncl.2023.06.009Cacciaguerra L., Flanagan E.P. Updates in NMOSD and MOGAD Diagnosis and Treatment: A Tale of Two Central Nervous System Autoimmune Inflammatory Disorders. Neurologic Clinics. 2024;42(1):77-114. https://doi.org/10.1016/j.ncl.2023.06.009Passeri M., Matthews E., Kammeyer R., Piquet A.L. Update in autoimmune and paraneoplastic myelopathies: Newly described antigen targets and antibody testing. Front. Neurol. 2022;13:972143. https://doi.org/10.3389/fneur.2022.972143Passeri M., Matthews E., Kammeyer R., Piquet A.L. Update in autoimmune and paraneoplastic myelopathies: Newly described antigen targets and antibody testing. Front. Neurol. 2022;13:972143. https://doi.org/10.3389/fneur.2022.972143Скоромец А.А., Афанасьев В.В., Скоромец А.П., Скоромец Т.А. Сосудистые заболевания спинного мозга. СПб.: Политехника, 2019:400.Skoromets A.A., Afanasyev V.V., Skoromets A.P., Skoromets T.A. Vascular diseases of the spinal cord. St. Petersburg: Polytechnics; 2019. (In Russ.)Zalewski N.L., Rabinstein A.A., Krecke K.N., Brown R.D.Jr., Wijdicks E.F.M., Weinshenker B.G. et al. Characteristics of Spontaneous Spinal Cord Infarction and Proposed Diagnostic Criteria. JAMA Neurol. 2019;76(1):56-63. https://doi.org/10.1001/jamaneurol.2018.2734Zalewski N.L., Rabinstein A.A., Krecke K.N., Brown R.D.Jr., Wijdicks E.F.M., Weinshenker B.G. et al. Characteristics of Spontaneous Spinal Cord Infarction and Proposed Diagnostic Criteria. JAMA Neurol. 2019;76(1):56-63. https://doi.org/10.1001/jamaneurol.2018.2734Murphy O.C., Barreras P., Villabona-Rueda A., Mealy M., Pardo C.A. Identification of specific causes of myelopathy in a large cohort of patients initially diagnosed with transverse myelitis. J. of the Neurological Sciences. 2022;442:120425. https://doi.org/10.1016/j.jns.2022.120425Murphy O.C., Barreras P., Villabona-Rueda A., Mealy M., Pardo C.A. Identification of specific causes of myelopathy in a large cohort of patients initially diagnosed with transverse myelitis. J. of the Neurological Sciences. 2022;442:120425. https://doi.org/10.1016/j.jns.2022.120425Cacciaguerra L., Sechi E., Rocca M.A., Filippi M., Pittock S.J., Flanagan E.P. Neuroimaging features in inflammatory myelopathies: A review. Front. Neurol. 2022;13:993645. https://doi.org/10.3389/fneur.2022.993645Cacciaguerra L., Sechi E., Rocca M.A., Filippi M., Pittock S.J., Flanagan E.P. Neuroimaging features in inflammatory myelopathies: A review. Front. Neurol. 2022;13:993645. https://doi.org/10.3389/fneur.2022.993645Barreras P., Fitzgerald K.C., Mealy M.A., Jimenez J.A., Becker D., Newsome S.D. et al. Clinical biomarkers differentiate myelitis from vascular and other causes of myelopathy. Neurology. 2018;90:e12-21. https://doi.org/10.1212/WNL.0000000000004765Barreras P., Fitzgerald K.C., Mealy M.A., Jimenez J.A., Becker D., Newsome S.D. et al. Clinical biomarkers differentiate myelitis from vascular and other causes of myelopathy. Neurology. 2018;90:e12-21. https://doi.org/10.1212/WNL.0000000000004765Levy M. Immune-Mediated Myelopathies. Continuum (Minneap Minn). 2024;30(1):180-198. https://doi.org/10.1212/CON.0000000000001382Levy M. Immune-Mediated Myelopathies. Continuum (Minneap Minn). 2024;30(1):180-198. https://doi.org/10.1212/CON.0000000000001382Lopez Chiriboga S., Flanagan E.P. Myelitis and other autoimmune myelopathies. Continuum (Minneap Minn). 2021;27(1):62-92. https://doi.org/10.1212/CON.0000000000000900Lopez Chiriboga S., Flanagan E.P. Myelitis and other autoimmune myelopathies. Continuum (Minneap Minn). 2021;27(1):62-92. https://doi.org/10.1212/CON.0000000000000900Pfausler B., Rass V., Lindner A. Infektionen des Rückenmarks und der angrenzenden Strukturen [Infections of the spinal cord and adjacent structures]. Nervenarzt. 2023;94(4):287-295. (In German). https://doi.org/10.1007/s00115-023-01439-xPfausler B., Rass V., Lindner A. Infektionen des Rückenmarks und der angrenzenden Strukturen [Infections of the spinal cord and adjacent structures]. Nervenarzt. 2023;94(4):287-295. (In German). https://doi.org/10.1007/s00115-023-01439-xFletcher A.M., Bhattacharyya S. Infectious Myelopathies. Continuum (Minneap Minn). 2024;30(1):133-159. https://doi.org/10.1212/CON.0000000000001393Fletcher A.M., Bhattacharyya S. Infectious Myelopathies. Continuum (Minneap Minn). 2024;30(1):133-159. https://doi.org/10.1212/CON.0000000000001393Marignier R. Acute and subacute myelopathy. Revue Neurologique. 2021;177(5):557-566. https://doi.org/10.1016/j.neurol.2020.08.003Marignier R. Acute and subacute myelopathy. Revue Neurologique. 2021;177(5):557-566. https://doi.org/10.1016/j.neurol.2020.08.003Fadda G., Flanagan E.P., Cacciaguerra L., Jitprapaikulsan J., Solla P., Zara P., Sechi E. Myelitis features and outcomes in CNS demyelinating disorders: Comparison between multiple sclerosis, MOGAD, and AQP4-IgG-positive NMOSD. Front. Neurol. 2022;13:1011579. https://doi.org/10.3389/fneur.2022.1011579Fadda G., Flanagan E.P., Cacciaguerra L., Jitprapaikulsan J., Solla P., Zara P., Sechi E. Myelitis features and outcomes in CNS demyelinating disorders: Comparison between multiple sclerosis, MOGAD, and AQP4-IgG-positive NMOSD. Front. Neurol. 2022;13:1011579. https://doi.org/10.3389/fneur.2022.1011579Пономарев Г.В., Скоромец А.А., Краснов В.С., Родионова О.В., Глистенкова Д.Д., Порхун Н.Ф., и др. Сосудистая миелопатия: причины и механизмы, возможности диагностики и лечения. Неврология, нейропсихиатрия, психосоматика. 2018;10(1):12-16.Ponomarev G.V., Skoromets A.A., Krasnov V.S., Rodionova O.V., Glistenkova D.D., Porkhun N.F., et al. Vascular myelopathy: causes and mechanisms, possibilities of diagnosis and treatment. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(1):12-16. (In Russ.) https://doi.org/10.14412/2074-2711-2018-1-12-16Murphy O.C., Salazar-Camelo A., Jimenez J.A., Barreras P., Reyes M.I., Garcia M.A. et al. Clinical and MRI phenotypes of sarcoidosis-associated myelopathy. Neurol. Neuroimmunol. Neuroinflamm. 2020;7:e722. https://doi.org/10.1212/NXI.0000000000000722Murphy O.C., Salazar-Camelo A., Jimenez J.A., Barreras P., Reyes M.I., Garcia M.A. et al. Clinical and MRI phenotypes of sarcoidosis-associated myelopathy. Neurol. Neuroimmunol. Neuroinflamm. 2020;7:e722. https://doi.org/10.1212/NXI.0000000000000722Fink J.K. Hereditary Myelopathies. Continuum (Minneap Minn). 2021;27(1):185-204. https://doi.org/10.1212/con.0000000000000934Fink J.K. Hereditary Myelopathies. Continuum (Minneap Minn). 2021;27(1):185-204. https://doi.org/10.1212/con.0000000000000934Kranz P.G., Amrhein T.J. Imaging approach to myelopathy: acute, subacute, and chronic. Radiol. Clin. North. Am. 2019;57:257-279. https://doi.org/10.1016/j.rcl.2018.09.006Kranz P.G., Amrhein T.J. Imaging approach to myelopathy: acute, subacute, and chronic. Radiol. Clin. North. Am. 2019;57:257-279. https://doi.org/10.1016/j.rcl.2018.09.006Sechi E., Morris P.P., McKeon A., Pittock S.J., Hinson S.R., Weinshenker B.G. et al. Glial fibrillary acidic protein IgG related myelitis: characterisation and comparison with aquaporin-4-IgG myelitis. J. Neurol. Neurosurg. Psychiatry. 2019;90:488-490. https://doi.org/10.1136/jnnp-2018-318004Sechi E., Morris P.P., McKeon A., Pittock S.J., Hinson S.R., Weinshenker B.G. et al. Glial fibrillary acidic protein IgG related myelitis: characterisation and comparison with aquaporin-4-IgG myelitis. J. Neurol. Neurosurg. Psychiatry. 2019;90:488-490. https://doi.org/10.1136/jnnp-2018-318004Banwell B., Bennett J.L., Marignier R., Kim H.Jin., Brilot F., Flanagan E.P. et al. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet. Neurol. 2023:22(3);268-282. https://doi.org/10.1016/S1474-4422(22)00431-8Banwell B., Bennett J.L., Marignier R., Kim H.Jin., Brilot F., Flanagan E.P. et al. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet. Neurol. 2023:22(3);268-282. https://doi.org/10.1016/S1474-4422(22)00431-8Saballegue J.D., Tiongson M.P. Rituximab Therapy for Double Seronegative Neuromyelitis Optica Spectrum Disease. Cureus 2024;16(5):e60004. https://doi.org/10.7759/cureus.60004Saballegue J.D., Tiongson M.P. Rituximab Therapy for Double Seronegative Neuromyelitis Optica Spectrum Disease. Cureus 2024;16(5):e60004. https://doi.org/10.7759/cureus.60004Zara P., Dinoto A., Carta S., Floris V., Turilli D., Budhram A. et al. Non-demyelinating disorders mimicking and misdiagnosed as NMOSD: a literature review. Eur. J. Neurol. 2023;30:3367-3376. https://doi.org/10.1111/ene.15983Zara P., Dinoto A., Carta S., Floris V., Turilli D., Budhram A. et al. Non-demyelinating disorders mimicking and misdiagnosed as NMOSD: a literature review. Eur. J. Neurol. 2023;30:3367-3376. https://doi.org/10.1111/ene.15983

The authors declare that there are no conflicts of interest present.