Department of Neurology, St. Elizabeth's Medical Center, Boston, Massachusetts.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Semin Neurol. 2021 Jun;41(3):309-326. doi: 10.1055/s-0041-1725150. Epub 2021 May 19.
Metabolic and toxic causes of myelopathy form a heterogeneous group of disorders. In this review, we discuss the causes of metabolic and toxic myelopathies with respect to clinical presentation, pathophysiology, diagnostic testing, treatment, and prognosis. This review is organized by temporal course (hyperacute, acute, subacute, and chronic) and etiology (e.g., nutritional deficiency, toxic exposure). Broadly, the myelopathies associated with dietary toxins (neurolathyrism, konzo) and decompression sickness present suddenly (hyperacute). The myelopathies associated with heroin use and electrical injury present over hours to days (acutely). Most nutritional deficiencies (cobalamin, folate, copper) and toxic substances (nitrous oxide, zinc, organophosphates, clioquinol) cause a myelopathy of subacute onset. Vitamin E deficiency and hepatic myelopathy cause a chronic myelopathy. Radiation- and intrathecal chemotherapy-induced myelopathy can cause a transient and/or a progressive syndrome. For many metabolic and toxic causes of myelopathy, clinical deficits may stabilize or improve with rapid identification and treatment. Familiarity with these disorders is therefore essential.
代谢和中毒性脊髓病是一组异质性疾病。在这篇综述中，我们将根据临床表现、病理生理学、诊断检测、治疗和预后讨论代谢和中毒性脊髓病的原因。本综述按时间进程（超急性、急性、亚急性和慢性）和病因（如营养缺乏、毒物暴露）进行组织。广义而言，与饮食毒素（神经毒性、科罗尼病）和减压病相关的脊髓病突然出现（超急性）。与海洛因使用和电损伤相关的脊髓病在数小时至数天内出现（急性）。大多数营养缺乏症（钴胺素、叶酸、铜）和有毒物质（一氧化二氮、锌、有机磷、氯碘羟喹）引起亚急性发病的脊髓病。维生素 E 缺乏和肝性脊髓病引起慢性脊髓病。放射和鞘内化疗引起的脊髓病可导致短暂和/或进行性综合征。对于许多代谢和中毒性脊髓病的原因，快速识别和治疗可能会使临床症状稳定或改善。因此，熟悉这些疾病是至关重要的。
