Kayal Ashok Kumar, Goswami Munindra, Das Marami, Basumatary Lakhshya Jyoti, Bhowmick Suvorit Subhas, Synmon Baiakmenlang
Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Ann Indian Acad Neurol. 2017 Jan-Mar;20(1):41-50. doi: 10.4103/0972-2327.199904.
The discovery of antibodies against aquaporin-4 and evolving concepts of noncompressive myelopathies in the 21 century have made a major impact on the etiological profile of these diseases, with few cases turning out to be idiopathic.
To find causes of noncompressive myelopathy in a tertiary care hospital of Northeast India.
An observational study was carried out in the Neurology Department of Gauhati Medical College, Guwahati, from September 2013 to February 2016. Patients of noncompressive myelopathies who underwent magnetic resonance imaging (MRI) of the spine were segregated into two categories: acute-to-subacute myelopathy (ASM) and chronic myelopathy (CM). In addition to routine blood tests, chest X-ray, urinalysis, and visual evoked potentials, investigations included MRI of the brain, cerebrospinal fluid analysis, and immunological, infectious, and metabolic profile based on the pattern of involvement.
The study had 151 patients (96 ASM and 55 CM) with a median age of 35 years and male: female ratio 1.4:1. The causes of ASM were neuromyelitis optica spectrum disorder (23), multiple sclerosis (MS) (8), systemic lupus erythematosus (1), Hashimoto's disease (1), postinfectious acute disseminated encephalomyelitis (6), postinfectious myelitis (8), infections (9), spinal cord infarct (5), and electrocution (1). The causes of CM were MS (1), probable or possible sarcoidosis (7), mixed connective tissue disease (1), Hashimoto's disease (2), infections (9), Vitamin B deficiency (4), folate deficiency (2), hepatic myelopathy (2), radiation (11), and paraneoplastic (1). No etiology could be found in 48 (31.8%) patients (34 ASM and 14 CM). In 21/96 (21.9%) patients of ASM, acute transverse myelitis was idiopathic based on current diagnostic criteria.
Underlying etiology (demyelinating, autoimmune, infectious, vascular, metabolic disorder, or physical agent) was found in 68% patients of noncompressive myelopathy.
21世纪水通道蛋白4抗体的发现以及非压迫性脊髓病概念的不断演变，对这些疾病的病因构成产生了重大影响，很少有病例被证明是特发性的。
在印度东北部的一家三级护理医院中寻找非压迫性脊髓病的病因。
2013年9月至2016年2月，在古瓦哈蒂高哈蒂医学院神经科进行了一项观察性研究。接受脊柱磁共振成像（MRI）检查的非压迫性脊髓病患者被分为两类：急性至亚急性脊髓病（ASM）和慢性脊髓病（CM）。除了常规血液检查、胸部X线、尿液分析和视觉诱发电位外，检查还包括脑部MRI、脑脊液分析以及基于受累模式的免疫、感染和代谢检查。
该研究有151例患者（96例ASM和55例CM），中位年龄为35岁，男女比例为1.4:1。ASM的病因包括视神经脊髓炎谱系障碍（23例）、多发性硬化症（MS）（8例）、系统性红斑狼疮（1例）、桥本氏病（1例）、感染后急性播散性脑脊髓炎（6例）、感染后脊髓炎（8例）、感染（9例）、脊髓梗死（5例）和触电（1例）。CM的病因包括MS（1例）、可能或疑似结节病（7例）、混合性结缔组织病（1例）、桥本氏病（2例）、感染（9例）、维生素B缺乏（4例）、叶酸缺乏（2例）、肝性脊髓病（2例）、放疗（11例）和副肿瘤性（1例）。48例（31.8%）患者（34例ASM和14例CM）未发现病因。根据当前诊断标准，在96例ASM患者中有21/96（21.9%）为特发性急性横贯性脊髓炎。
在68%的非压迫性脊髓病患者中发现了潜在病因（脱髓鞘、自身免疫、感染、血管、代谢紊乱或物理因素）。
