Health Questions and Answers

MYELOPATHIES

What are the most common causes of spinal cord disease?
The most common cause of chronic spinal cord compression is cervical spondylosis. If there is no history of trauma, the acute syndrome is often due to compression by a neoplasm, usually metastatic. Such compression may develop almost instantaneously and may or may not cause back pain. Besides compression, other causes include cord infarction, vitamin B12 deficiency, HIV infection, and inflammation such as multiple sclerosis or transverse myelins.

How does spinal cord compression present clinically?
Spinal cord compression causes the classic cord syndrome of a sensory level, bowel and bladder changes, and upper motor neuron weakness with spasticity, hyperreflexia, and a positive Babinski sign. Superficial reflexes, such as abdominal reflexes and the anal wink, may be diminished.

How is spinal cord compression best diagnosed?
The first step is to localize the site of the lesion. Plain x-rays of the spine have a high yield for showing metastatic disease, as evidenced by lytic lesions and erosion of pedicles. Bone scans lack specificity and are generally of low yield. MRI has largely replaced myelography for the definitive documentation of compression.

Summarize the treatment for spinal cord compression.
Surgical intervention is indicated for compression due to cervical spondylosis or mechanical deformation, such as spondylolisthesis. For neoplastic compression, radiation therapy is increasingly favored over surgical decompression, since results are equally good in many studies. Otherwise, surgery may be needed for diagnosis as well as treatment. In either case, high-dose IV steroids, such as 100 mg of dexamethasone daily, may provide additional relief.

KEY POINTS: NEUROLOGY I

  • Myopathies cause proximal symmetric weakness without sensory loss and with little change in tone or reflexes.
  • Neuromuscular junction diseases cause proximal symmetric weakness that fluctuates (fatigues), without pain or sensory loss.
  • Neuropathies usually cause distal weakness, often asymmetric, with atrophy, sensory loss, and pain.
  • Most back pain is not caused by a radiculopathy.
  • Myelopathies cause a sensory level.

References
WEB SITES
www.neuroguide.com
www.aan.com (American Academy of Neurology)
www.medmatrix.org
www.internets.com/mednets/sneurolo.htm
www.medwebplus.com/subject/Neurology.html

BIBLIOGRAPHY

  • Armstrong R: Myelopathies. In Rolak LA (ed): Neurology Secrets. Philadelphia, Hanley & Belfus, 1998, pp 103-111.
  • Noseworthy JH (ed): Neurologic Therapeutics. London, Martin Dunitz, 2003.
  • Bradley WG, Daroff RB, Fenichel GM, Jankovic J: Neurology in Clinical Practice, 4th ed. Philadelphia, Butterworth-Heinemann, 2004.
  • Caplan LR: Stroke: A Clinical Approach, 3rd ed. New York, Butterworth-Heinemann, 2000.
  • Samuels MA, Feske S (eds): Office Practice of Neurology, 2nd ed. Boston, Churchill-Livingstone, 2003.
  • Johnson RT, Griffin JW: Current Therapy in Neurologic Disease, 6th ed. St. Louis, Mosby, 2002.
  • Rolak LA (ed): Neurology Secrets, 4th ed. Philadelphia, Hanley & Belfus, 2005.
  • Victor M, Ropper AH: Prinicples of Neurology, 7th ed. New York, McGraw-Hill, 2001.

One Response to “MYELOPATHIES”

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