Fifty-two patients with acute and subacute transverse myelopathy (TM) were evaluated at the Massachusetts General Hospital between 1955 and 1975 and followed for 1 to 23 years (average, 5). Nineteen had symptoms of a recent acute infectious illness, 3 had cancer, and 1 had undergone a recent operation. There were four types of initial symptom. Twenty-four patients had paresthesias at the onset of the illness, 18 had pain, usually interscapular, 7 had leg weakness, and 3 had urine retention. Prognosis depended on the nature of the onset of TM. An acute catastrophic onset was generally associated with back pain and led to a poor outcome in 7 and a good outcome in only 1 of 11 patients. A subacute progressive onset over several days to four weeks, generally with ascending paresthesias or leg weakness, was associated with a good outcome in 15 and fair outcome in 17 of 37 patients. Preceding febrile illness, treatment with corticosteroids, and the nature of CSF abnormalities had no effect on outcome. Multiple sclerosis evolved in 7 patients during the follow-up period. Because of the frequency with which mass lesions were missed, the need for myelography in the diagnosis of TM is emphasized. The distinguishing clinical characteristics of TM provide guidelines for diagnosis and prognosis.
To determine the prevalence of radiologically evident carotid stenosis in patients with transient cerebral ischemic attacks, we analyzed 95 consecutive hospitalized patients who during a two-year period had appropriate symptoms and also underwent angiography. Pure transient hemisphere symptoms affected 52 patients, pure monocular blindness occurred in 33, and 10 experienced each type of attack separately. Tight stenosis (less than or equal to 2 mm) or occlusion was present in 49 patients (52 per cent). Thirteen patients showed intracranial-branch occlusion, nine of whom had no notable stenosis. Only two clinical transient ischemic attack features correlated with angiographic findings: in transient hemisphere attacks lasting for one hour or longer, the carotid arteries revealed no notable stenosis (0.05 less than P less than 0.1); and separate hemisphere and ocular attacks in the same patient correlated with tight carotid stenosis. On the basis of the angiographic findings, the study indicates there are several distinct groups of patients with carotid transient ischemic attacks.
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