Anusha, D (2014) A Study of the Clinical Spectrum and Functional Outcome of Patients with Nontraumatic Myelopathy. Masters thesis, Madras Medical College, Chennai.
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Abstract
The spinal cord is a vital and delicate structure of the central nervous system that is cushioned within the CSF, surrounded by the meningeal coverings, strong ligaments and encased within the protection of interlocking vertebral bones. Diseases of the spinal cord are termed as myelopathies, which can be secondary to trauma or may be due to non-traumatic causes. Nontraumatic myelopathies are of two types: compressive myelopathies and non-compressive myelopathies. Myelopathies commonly present with motor and sensory deficits along with sphincter disturbances. The clinical presentation and causes of compressive myelopathies characteristically differ from those of noncompressive myelopathies, although rare presentations in either category can mimic each other1 and pose a diagnostic dilemma to the astute clinician. The common causes of spinal cord compression are Pott‟s spine, fractures, infective abscess, arteriovenous malformations, spondylotic changes, spinal instability, tumours, multiple myeloma and metastases. The non-compressive myelopathies have wide and diverse etiologies like infective, inflammatory, demyelinating, vascular, hereditary causes or can be secondary to toxic exposure, metabolic disorders or nutritional deficiencies. Myelopathies usually present with devastating neurological consequences like para-/quadriparesis, neurogenic bladder, decubitus ulcers, spasticity, etc which can impair the quality of life and independence of the affected individual. The sequelae of spinal cord disorders are myriad, with few diseases like subacute combined degeneration showing dramatic response to treatment, producing only a mild impact on the patient‟s daily life, whereas some cases of acute transverse myelitis or cord compression can hamper the vital functions of mobility, sensation, bladder and bowel control, making the patient completely dependent on their caregivers. Little information regarding the functional outcome of nontraumatic myelopathies as a whole is available in the current literature, although the outcome of few specific myelopathies like cervical spondylotic myelopathy and acute transverse myelitis has been described. CONCLUSION : 1. The spectrum of nontraumatic myelopathy in our study population showed equal distribution of compressive as well as non-compressive myelopathy. 2. While the commonest cause of compressive myelopathy was cervical spondylotic myelopathy, demyelinating diseases with acute transverse myelitis presentation was the most common cause of non-compressive myelopathy. 3. The most common location for cord lesion was in the cervical cord based on radiological evaluation. 4. Significant number of patients remained static in their functional status at the end of 6 months. 5. Quadriparesis and bladder symptoms at initial presentation significantly showed association with the 6-month functional outcome, whereas LETM lesions on MRI showed significant association with the functional status at first presentation.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Nontraumatic Myelopathy ; Clinical Spectrum Study ; Functional Outcome of Patients. |
| Subjects: | MEDICAL > Neurology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 30 Jun 2017 02:39 |
| Last Modified: | 30 Jun 2017 05:34 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/663 |
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