Pradhan S, Gupta R K, Kapoor R, Shashank S, Kathuria M K
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Neurol Sci. 1998 Dec 11;161(2):156-62. doi: 10.1016/s0022-510x(98)00277-9.
We describe electroclinical and imaging features of a peculiar type of parainfectious myelitis that selectively involves the conus/epiconus region of the spinal cord. Twelve patients of parainfectious myelitis with MRI evidence of inflammatory lesions in the conus/epiconus region of the spinal cord were studied. All patients underwent full clinical and electrophysiological evaluation along with MRI of the spine. MRI included axial images at the site of lesion. All patients had a unique clinical presentation with urinary symptoms. Careful clinical examination revealed minimal sensorimotor dysfunction in the lower lumbar and sacral segments, which remained unnoticed by most of the patients; three female patients had no sensorimotor deficit. The motor paralysis recorded in four patients was flaccid and areflexic. The sensory level was inconspicuous as it was in the leg area corresponding to the lumbar and sacral spinal segments. Sensory loss was significantly more in the perineal region in those seven patients who had MRI evidence of inflammatory lesion in conus medullaris; two patients had maximum sensory loss in lumbar dermatomal distribution, which corresponded with the focal segmental myelitis involving 'epiconus'. MRI done in the sagittal plane was either normal or only 'suggestive' of myelitis in most of the patients and the inflammatory lesions were much more visible in the axial plane. The lesions predominantly involved central gray matter with spread to adjoining white matter in nine patients; in three patients with pure bladder involvement, lesions were confined to lateral gray matter of the conus medullaris. Our findings indicate that parainfectious myelitis (PIM) selectively involving conus medullaris is an important cause of unexplained acute or sub-acute urinary symptoms in adolescent and adult patients. In suspected cases, MRI must include axial images of the conus-epiconus region, as sagittal images may not always reveal the lesion. Due to initial presentation with urinary symptoms, absent or minimal sensory-motor signs, no transverse level over the trunk and unique MRI features, this condition may be called parainfectious conus myelitis (PICM).
我们描述了一种特殊类型的感染后脊髓炎的临床电生理和影像学特征，该类型脊髓炎选择性累及脊髓圆锥/圆锥上区。对12例有脊髓圆锥/圆锥上区炎性病变MRI证据的感染后脊髓炎患者进行了研究。所有患者均接受了全面的临床和电生理评估以及脊柱MRI检查。MRI包括病变部位的轴位图像。所有患者均有独特的临床表现，伴有泌尿系统症状。仔细的临床检查发现，大多数患者下腰段和骶段存在轻微的感觉运动功能障碍，但未被注意到；3例女性患者无感觉运动功能缺损。4例患者记录的运动性麻痹为弛缓性且无反射。感觉平面不明显，因为其位于与腰段和骶段脊髓节段相对应的腿部区域。7例脊髓圆锥有炎性病变MRI证据的患者，其会阴区感觉丧失明显更严重；2例患者最大感觉丧失位于腰段皮节分布区，这与累及“圆锥上区”的局灶性节段性脊髓炎相对应。大多数患者矢状面MRI检查结果正常或仅“提示”有脊髓炎，而炎性病变在轴位平面上更明显。9例患者病变主要累及中央灰质，并蔓延至相邻白质；3例单纯膀胱受累患者，病变局限于脊髓圆锥外侧灰质。我们的研究结果表明，选择性累及脊髓圆锥的感染后脊髓炎（PIM）是青少年和成年患者不明原因急性或亚急性泌尿系统症状的重要原因。在疑似病例中，MRI必须包括脊髓圆锥 - 圆锥上区的轴位图像，因为矢状面图像可能并不总能显示病变。由于最初表现为泌尿系统症状、感觉运动体征缺失或轻微、躯干无横贯性平面以及独特的MRI特征，这种情况可称为感染后圆锥脊髓炎（PICM）。
