Continuum (Minneap Minn). 2021 Feb 1;27(1):143-162. doi: 10.1212/CON.0000000000000963.
This article describes the clinical presentation, relevant diagnostic investigations, and treatment of metabolic and toxic myelopathies.
Metabolic myelopathies, including those due to deficiency of vitamin B12, folate, copper, or vitamin E, are preventable and typically respond to supplementation. In metabolic myelopathy, early recognition and treatment are important to reduce morbidity, particularly due to subacute combined degeneration of the spinal cord. Toxic myelopathies, including those due to medical interventions (eg, methotrexate, radiation), dietary toxins (eg, lathyrism, konzo), and drugs of abuse (eg, heroin), typically result in permanent neurologic deficits. Toxic myelopathy due to hepatic dysfunction may be reversible if patients receive early intervention, whereas nitrous oxide myelopathy responds to vitamin B12 replacement and cessation of exposure. In toxic myelopathy, it is best to avoid the provoking factor when possible or attempt to mitigate risk by identifying risk factors for developing myelopathy.
Metabolic and toxic myelopathies are important causes of morbidity that require a high index of suspicion for diagnosis.
本文描述了代谢性和中毒性脊髓病的临床表现、相关诊断检查和治疗方法。
代谢性脊髓病，包括因维生素 B12、叶酸、铜或维生素 E 缺乏引起的脊髓病，是可预防的，通常对补充治疗有反应。在代谢性脊髓病中，早期识别和治疗对于降低发病率非常重要，尤其是脊髓亚急性联合变性。中毒性脊髓病，包括因医疗干预（如甲氨蝶呤、放疗）、饮食毒素（如豆科植物中毒、疯牛病）和滥用药物（如海洛因）引起的脊髓病，通常会导致永久性神经功能缺损。如果患者接受早期干预，肝性功能性脊髓病可能是可逆的，而一氧化二氮脊髓病则对维生素 B12 替代治疗和停止接触有反应。在中毒性脊髓病中，最好尽可能避免诱发因素，或通过识别发生脊髓病的风险因素来尽量降低风险。
代谢性和中毒性脊髓病是导致发病率的重要原因，需要高度怀疑诊断。
