West Timothy W
Lou Ruvo Center for Brain Health and the Mellen Center for Multiple Sclerosis Treatment and Research Neurological Institute, Department of Neurology, Cleveland Clinic, Las Vegas, Nevada 89106, USA.
Discov Med. 2013 Oct;16(88):167-77.
Myelitis is a rare neurological disorder of the spinal cord that is caused by inflammation and can have devastating neurologic effects with up to two-thirds of patients having a moderate to severe degree of residual disability. Symptoms typically develop over hours or days and then worsen over a matter of days to weeks. Patients can present with sensory alteration, weakness, and autonomic dysfunction including bowel and bladder problems, temperature dysregulation, or even bouts of hypertension. Evaluation for compressive etiologies must be a priority as compressive myelopathy and transverse myelitis are often clinically indistinguishable and emergent surgical intervention is indicated in such cases. However, if neuroimaging and CSF studies indicate inflammation within the central nervous system, then a work-up for myelitis must include autoimmune, inflammatory, and infectious etiologies. Acute management of these patients is dictated by which etiology is suspected and rapid initiation of that treatment portends a more favorable patient outcome. This review will discuss a practical clinical approach to the diagnosis and acute management of patients with myelitis including clinical symptoms, the role of neuroimaging, and the utility of both CSF and serological studies in the management of these patients.
脊髓炎是一种罕见的脊髓神经系统疾病，由炎症引起，可产生严重的神经功能影响，多达三分之二的患者会有中度至重度的残余残疾。症状通常在数小时或数天内出现，然后在数天至数周内恶化。患者可能出现感觉改变、虚弱以及自主神经功能障碍，包括肠道和膀胱问题、体温调节异常，甚至高血压发作。必须优先评估压迫性病因，因为压迫性脊髓病和横贯性脊髓炎在临床上往往难以区分，此类情况下需紧急进行手术干预。然而，如果神经影像学和脑脊液检查表明中枢神经系统存在炎症，那么对脊髓炎的检查必须包括自身免疫性、炎症性和感染性病因。这些患者的急性治疗取决于怀疑的病因，迅速开始相应治疗预示着患者会有更良好的预后。本综述将讨论脊髓炎患者诊断和急性治疗的实用临床方法，包括临床症状、神经影像学的作用以及脑脊液和血清学检查在这些患者治疗中的效用。
