Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
Department of Microbiology, King George Medical University, Lucknow, Uttar Pradesh, India.
Neurol India. 2018 Jan-Feb;66(1):65-70. doi: 10.4103/0028-3886.222877.
We evaluated the spectrum of acquired demyelinating and inflammatory disorders in patients presenting with an acute transverse myelopathy. We also studied differences between an acute idiopathic transverse myelitis and myelitis resulting from other etiologies.
Eighty consecutive patients with acute transverse myelopathy were included. At inclusion, clinical profile, serum and cerebrospinal fluid parameters, brain and spinal cord magnetic resonance imaging, and visual evoked potentials were obtained. All patients were given methylprednisolone therapy. Patients were followed up for 6 months. Outcome was assessed using modified Barthel index. A modified Barthel index score of ≤12 indicated a poor prognosis.
Majority (n = 49; 61.25%) of patients had idiopathic acute transverse myelitis. Eleven cases had neuromyelitis optica spectrum disorders (8 had anti-aquaporin antibody positivity). Multiple sclerosis was diagnosed in 7 cases. Eight cases had infectious or parainfectious myelitis. Longitudinally extensive transverse myelitis was noted in 66 (82.5%) patients. Seventeen patients had abnormalities in the brain. Majority of patients improved following methylprednisolone therapy. On univariate analysis, delay in administering methylprednisolone therapy, poor modified Barthel index at discharge, and extensive cord involvement were associated with severe residual disability. On multivariate analysis, delayed initiation of methylprednisolone was identified as a poor prognostic factor.
A variety of inflammatory, infective, demyelinating, and autoimmune disorders present with acute transverse myelopathy. Early institution of methylprednisolone reduces the disability in these patients.
我们评估了急性横贯性脊髓炎患者中获得性脱髓鞘和炎症性疾病的谱。我们还研究了急性特发性横贯性脊髓炎和其他病因引起的脊髓炎之间的差异。
共纳入 80 例急性横贯性脊髓炎患者。纳入时，获得临床特征、血清和脑脊液参数、脑和脊髓磁共振成像以及视觉诱发电位。所有患者均接受甲基强的松龙治疗。患者随访 6 个月。使用改良巴氏指数评估预后。改良巴氏指数评分≤12 表示预后不良。
大多数（n=49；61.25%）患者为特发性急性横贯性脊髓炎。11 例为视神经脊髓炎谱系疾病（8 例抗水通道蛋白抗体阳性）。诊断为多发性硬化症 7 例。8 例为感染性或副感染性脊髓炎。66 例（82.5%）患者为长节段横贯性脊髓炎。17 例患者脑内有异常。大多数患者经甲基强的松龙治疗后病情改善。单因素分析显示，甲基强的松龙治疗延迟、出院时改良巴氏指数较差和脊髓广泛受累与严重的残留残疾相关。多因素分析显示，甲基强的松龙治疗延迟是预后不良的因素。
各种炎症、感染、脱髓鞘和自身免疫性疾病均可表现为急性横贯性脊髓炎。早期使用甲基强的松龙可降低这些患者的残疾程度。
