Schwendimann Robert N
Continuum (Minneap Minn). 2018 Apr;24(2, Spinal Cord Disorders):427-440. doi: 10.1212/CON.0000000000000596.
Myelopathy may occur as a consequence of various metabolic and toxic conditions. This article provides an update on the clinical presentations, diagnostic evaluations, and management of metabolic and toxic myelopathies.
Myelopathy and myeloneuropathy due to vitamin B12 deficiency is increasing in prevalence partly because of an aging population. Early recognition of the clinical symptoms and rapid initiation of treatment is essential. Copper deficiency is now also recognized as causing a similar clinical picture as vitamin B12 deficiency. Conditions leading to copper deficiency include bariatric surgery and excessive zinc intake. Unusual conditions such as lathyrism and konzo are relevant to all neurologists because of emigration from less well-developed countries. Myelopathy can also occur from substance abuse (eg, heroin and nitrous oxide), and early diagnosis could lead to improved patient outcomes. The spinal cord may also be injured in decompression illness that occurs in sport divers and individuals who work in pressurized atmospheres.
Knowledge and recognition of the various metabolic and toxic causes of myelopathy is important for the practicing neurologist, as timely diagnosis and rapid initiation of therapy is essential to improve the chances for recovery.
脊髓病可能由多种代谢和中毒情况引起。本文提供了代谢性和中毒性脊髓病的临床表现、诊断评估及治疗的最新信息。
由于人口老龄化，维生素B12缺乏所致的脊髓病和脊髓神经病患病率正在上升。早期识别临床症状并迅速开始治疗至关重要。铜缺乏现在也被认为会导致与维生素B12缺乏相似的临床表现。导致铜缺乏的情况包括减肥手术和锌摄入过量。由于来自欠发达国家的移民，像山黧豆中毒和konzo（一种热带痉挛性截瘫）等罕见情况对所有神经科医生来说都很重要。脊髓病也可能由药物滥用（如海洛因和一氧化二氮）引起，早期诊断可能会改善患者预后。在从事潜水运动的人和在加压环境中工作的个体中发生的减压病也可能损伤脊髓。
对于执业神经科医生来说，了解和认识脊髓病的各种代谢和中毒原因很重要，因为及时诊断和迅速开始治疗对于提高恢复机会至关重要。
