Subacute delayed ascending myelopathy: not just a post-traumatic disorder

Study design: Case report. Objectives: Subacute delayed ascending myelopathy (SDAM), also known as subacute post-traumatic ascending myelopathy, is a rare early neurological complication of spinal cord injury (SCI), and the aetiology, pathogenesis and optimal management of this condition are poorly understood. The radiological features together with the clinical picture appear to be the most useful. We aim to increase awareness and further characterise SDAM. Setting: Spinal Cord Injuries Unit, Royal North Shore Hospital, Sydney, Australia. Methods and Results: We report two cases with radiological findings consistent with SDAM, and review the literature. Only a small number of cases have been reported and importantly, we report the first case occurring following a non-traumatic SCI. There are several hypotheses regarding pathogenesis, with several factors in our cases implicating a vascular mechanism. Conclusion: There is a lack of data characterising SDAM, and ascending myelopathy in a stable SCI should alert the clinician. Importantly, we propose that SDAM is the appropriate terminology.