Snapshot A 37-year-old male presents with lower extremity numbness, weakness, and sexual dysfunction. His symptoms began 2 days prior, and has progressively worsened. Medical history is significant for pneumonia caused by Mycoplasma pneumoniae. He denies weight loss, night sweats, or recent vaccinations. Physical exam is notable for bilateral lower extremity sensory deficits and motor weakness. Both bulbocavernous and anal wink reflex are absent. MRI of the brain and spine are performed. There is no intracranial pathology. There is a gadolinium enhancing lesion on greater than two spinal cord levels in the lumbar spine. A lumbar puncture is performed, which shows cerebrospinal fluid pleocytosis, and an increased IgG index. Introduction Neuro-inflammary disease of the spinal cord login to view 4 more bullets There is pathologic heterogeneity login to view 1 more bullet Can have a partial or complete effect on the spinal cord Epidemiology Affects any age Bimodal distribution login to view 1 more bullet Predilection depends on the underlying etiology of the lesion Etiology Post-infectious login to view 8 more bullets Post-vaccination Demyelinating disease login to view 3 more bullets Systemic autoimmune disease login to view 4 more bullets Medications login to view 2 more bullets Presentation Symptoms - acute or subacute development login to view 4 more bullets Physical exam login to view 5 more bullets Evaluation Must rule-out other causes of spinal cord compression login to view 2 more bullets MRI login to view 6 more bullets Lumbar puncture login to view 2 more bullets Blood tests login to view 2 more bullets Differential Spinal cord compressive lesion login to view 1 more bullet Nutritional deficiency login to view 1 more bullet Vascular causes login to view 2 more bullets Radiation myelitis Treatment High dose corticosteroids login to view 1 more bullet Plasma exchange login to view 1 more bullet