Pradhan S, Gupta R K, Ghosh D
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Acta Neurol Scand. 1997 Apr;95(4):241-7. doi: 10.1111/j.1600-0404.1997.tb00105.x.
Seventeen parainfectious myelitis patients were studied for site, extent and severity of lesions. Three patterns were observed each having distinct clinical, electrophysiological and MRI features: 1) focal segmental myelitis--focal cord lesion with long tract signs and good prognosis; 2) ascending myelitis--continuous lesion from conus to mid-cord with upper and lower motor neuron signs (not necessarily spinal shock), dysautonomia and poor outcome; 3) disseminated myelitis--discrete lesions scattered throughout the cord with subtle signs in spinal segmental distribution, above and below the transverse level and moderate outcome. Severe autonomic dysfunction, denervation of paraspinal muscles, "dense" lesion on imaging and often (but not always) the absent somatosensory evoked potentials carried poor outcome. In conclusion "parainfectious myelitis" is a better term to describe transverse myelitis, as the lesion extends to a large vertical extent. Further classification into 3 subgroups may improve understanding of anatomical and physiological dysfunction and prediction of outcome.
对17例感染后脊髓炎患者的病变部位、范围和严重程度进行了研究。观察到三种模式，每种模式都有独特的临床、电生理和MRI特征：1）局灶性节段性脊髓炎——伴有长束征的局灶性脊髓病变，预后良好；2）上升性脊髓炎——从圆锥到脊髓中部的连续性病变，伴有上下运动神经元体征（不一定有脊髓休克）、自主神经功能障碍，预后不良；3）播散性脊髓炎——离散性病变散在分布于整个脊髓，在脊髓节段分布区域、横断平面上下有轻微体征，预后中等。严重的自主神经功能障碍、椎旁肌失神经支配、影像学上的“致密”病变以及体感诱发电位常常（但并非总是）缺失提示预后不良。总之，“感染后脊髓炎”是描述横贯性脊髓炎的一个更好的术语，因为病变在垂直方向上累及范围较大。进一步分为3个亚组可能有助于更好地理解解剖和生理功能障碍以及预测预后。
