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Lookup NU author(s): Dr Beatriz Madureira, Dr Anderson Brito da Silva, Dr Mat Elameer, Alasdair Gebbels, Dr Andrew Schaefer, Dr Naomi Warren, Professor Mark BakerORCiD
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© Fondazione Società Italiana di Neurologia 2026.Background: Radiology, particularly MRI, is critical for the diagnosis and timely management of spinal cord injury. In 20–25% of patients with clinical signs of myelopathy MR imaging is normal; this can be challenging diagnostically and delay the instigation of life-changing therapeutic interventions. Investigations that specifically probe the physiology of spinal white matter tracts, both the ascending pathways (somatosensory evoked potentials; SEPs) and descending pathways (motor cortical evoked potentials; MEPs), could provide additional information but their application in this context has not been widely reported. Objective: To explore the utility of MEPs/SEPs in both the diagnosis and management of MRI-scan-negative myelopathy, particularly MRI-negative acute inflammatory myelopathy. Methods: Review of referrals made between 2021 and 2023 to the clinical neurophysiology department at a regional clinical neuroscience unit in the UK. Extraction and review of case records of those with normal initial/acute neuroimaging referred for neurophysiologic investigation of suspected spinal myelopathy. Results: We describe the clinical presentation, clinical course and neurophysiology in six patients who presented between 2021 and 2023 with MRI-scan-negative myelopathy. All had abnormal MEPs and SEPs. Five of six cases were subsequently diagnosed with inflammatory myelopathy. Conclusion: These cases illustrate the important role MEPs and SEPs play in diagnosing and managing MRI-scan-negative myelopathy.
Author(s): Madureira BIE, Da Silva AB, Elameer M, Fry CA, Gebbels A, Cassidy A, Duddy ME, Schaefer AM, Warren NM, Williams TL, Baker MR
Publication type: Article
Publication status: Published
Journal: Neurological Sciences
Year: 2026
Volume: 47
Issue: 3
Online publication date: 14/02/2026
Acceptance date: 15/01/2026
ISSN (print): 1590-1874
ISSN (electronic): 1590-3478
Publisher: Springer-Verlag
URL: https://doi.org/10.1007/s10072-026-08839-2
DOI: 10.1007/s10072-026-08839-2
PubMed id: 41688777
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