Misra U K, Kalita J, Kumar S
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Neurol Sci. 1996 Jun;138(1-2):150-6. doi: 10.1016/0022-510x(95)00353-4.
There is paucity of studies correlating the MRI and evoked potential changes in acute transverse myelitis (ATM). We studied ten patients with ATM (age range 14-57 years; 8 men, 2 women) who were subjected to clinical, MRI and neurophysiological evaluation. The latter included median and tibial somatosensory evoked potentials (SEP), motor evoked potentials (MEP) to upper and lower limbs and concentric needle EMG. The outcome was defined on the basis of three month Barthel Index score. All the patients had pronounced lower limb and three had upper limb weakness. Magnetic resonance imaging scans revealed diffuse to hypointense lesions in T1, which became hyperintense in T2 in all except one patient, who had patchy hyperintense lesions in both T1 and T2 sequences suggesting haemorrhage. The signal changes extended at least three segments above the sensory level. Tibial SEP and central motor conduction time to tibialis anterior (CMCT-TA) were abnormal in nine patients each. Median SEP was normal in all, but CMCT to abductor digiti minimi (CMCT-ADM) was abnormal in four patients. The extent of MRI signal alterations and CMCT-TA correlated with the outcome. Seven patients had a poor outcome, in them MRI changes extended 10 spinal segments or more. In these patients, MEP on lumbar stimulation was either unrecordable or of low amplitude and extensive fibrillations were present in the lower limb muscles. From this study, we conclude that in ATM, extensive MRI changes, unrecordable MEP to lower limbs especially on lumbar stimulation and evidence of denervation in leg muscles seem to predict a poor outcome.
关于急性横贯性脊髓炎（ATM）中MRI与诱发电位变化相关性的研究较少。我们研究了10例ATM患者（年龄范围14 - 57岁；8例男性，2例女性），对其进行了临床、MRI和神经生理学评估。后者包括正中神经和胫神经体感诱发电位（SEP）、上下肢运动诱发电位（MEP）以及同心针肌电图。结局根据三个月的巴氏指数评分来定义。所有患者均有明显的下肢无力，3例有上肢无力。磁共振成像扫描显示T1加权像上有弥漫性至低信号病变，除1例患者外，所有患者在T2加权像上均变为高信号，该例患者在T1和T2序列上均有斑片状高信号病变提示出血。信号改变至少延伸至感觉平面以上三个节段。9例患者的胫神经SEP和胫前肌中枢运动传导时间（CMCT - TA）异常。所有患者的正中神经SEP均正常，但4例患者的小指展肌CMCT（CMCT - ADM）异常。MRI信号改变程度和CMCT - TA与结局相关。7例患者结局较差，他们的MRI改变延伸至10个或更多脊髓节段。在这些患者中，腰段刺激时的MEP要么无法记录，要么波幅低，下肢肌肉存在广泛的纤颤。从这项研究中，我们得出结论，在ATM中，广泛的MRI改变、下肢尤其是腰段刺激时无法记录的MEP以及腿部肌肉失神经支配的证据似乎预示着结局较差。
