Clinical, Radiological and Electro Physiological study in patients with Compressive and Non Compressive Myelopathy

Sankara Subramanian, K (2012) Clinical, Radiological and Electro Physiological study in patients with Compressive and Non Compressive Myelopathy. Masters thesis, Madras Medical College, Chennai.


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BACKGROUND: The etiological spectrum of spinal cord disease or myelopathy is diverse. Broadly they are classified into compressive and non-compressive myelopathy. The clinical presentation of these spinal cord diseases are diverse. With the advent of Magnetic Resonance Imaging (MRI) diagnosis of myelopathy has become easier. But there are certain diseases where at times the MRI can be normal and Somatosensory Evoked Potentials (SSEP) help in diagnosing the involvement of spinal cord. AIMS AND OBJECTIVES: 1. To study and analyse the clinical and radiological features of compressive and non-compressive myelopathy. 2. To determine the utility of SSEPs in compressive and non-compressive myelopathy. MATERIALS AND METHODS: Fifty two patients with features of myelopathy were included (compressive myelopathy-26 and noncompressive myelopathy- 26) in the study. Relevant blood investigations, Cerebrospinal fluid analysis, MRI and SSEPs were done. Twenty age and sex matched controls were included in the study and SSEPs were done for them. Patients with coexisting neuropathy,radiculopathy, plexus lesion, brain stem and cerebral cortical lesions were excluded. RESULTS: Cervical spondylosis was the most common etiology of compressive myelopathy followed by Tuberculosis of spine. Acute transverse myelitis was the commonest cause among the non-compressive myelopathies. Median SSEPs showed absent N13 potential in cervical spondylotic myelopathy with cord compression at C5, C5 segment. In acute transverse myelitis the thoracic cord was the commonest site of involvement and tibial SSEPs showed prolonged central conduction time from N20 (T12 level) to N28(C5 segment). SSEPs were helpful in identifying the cord involvement in subacute combined degeneration (SACD) and HIV myelopathy patients were MRI was normal. CONCLUSION: In patients with cervical spondylotic myelopathy (CSM) who had intact posterior column sensations median SSEP’s were abnormal indicating subclinical involvement. Absent or prolonged latencies of N13 potential in median SSEP correlated with absent or reduced tendon reflexes of C5 and C6 segment. In patients with subacute combined degeneration of the cord and HIV myelopathy having normal MRI, posterior column involvement is indicated by abnormal SSEPs.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Compressive and Non Compressive Myelopathy, Clinical, Radiological, Electro Physiological study.
Subjects: MEDICAL > Neurology
Depositing User: Subramani R
Date Deposited: 11 Feb 2020 01:02
Last Modified: 11 Feb 2020 01:02

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