A Study on Etiological Profile of Non-Compressive Myelopathies in a Tertiary Care Hospital in Central Tamilnadu

Abstract

Introduction: Non compressive myelopathy is defined as "spinal cord dysfunction in the absence of clinico-radiological evidence of spinal cord compression." It can result from demyelinating, infectious, autoimmune, vascular, degenerative and metabolic disorders in the absence of demonstrable compression by imaging techniques. We aimed in analyzing the etiological profile of non-compressive myelopathies in a tertiary care hospital of Central Tamil nadu. Material and Methods: In the Neurology department, we conducted an observational study at Thanjavur Medical College, Thanjavur, from September 2017 to September 2018. Patients of non-compressive myelopathies who underwent magnetic resonance imaging (MRI) of the spine were segregated into two categories: Degenerative and non-Degenerative, as well as into acute, subacute and chronic myelopathies.Results: The study had 75 patients with a median age of 34.5 years and male: female ratio of 1.35:1. Presentation was acute in 10 patients (13%), subacute in 5 (6.5%), chronic in 54 (72.5%) and history of relapse and remission in 6(8%) patients. Degenerative etiology was found for 42 (56%) others were non degenerative (demyelinating, autoimmune, vascular, nutritional, or physical agent). MRI study carried out in all cases showed signal changes in 51 cases (68%) which included myelomalacia, demyelination, atrophy of cord, infarction of cord. Etiological diagnosis could be established in 74 (97.3%) cases. Conclusion:Underlying etiology (degenerative, demyelinating, autoimmune, infectious, vascular, metabolic disorder, or physical agent) was found in 91.3% patients of noncompressive myelopathy. Clinical features combined with MRI findings are helpful in defining the cause of non-compressive myelopathies. A follow-up of long term may reveal some of the diagnosis especially degenerative myelopathies in early stage.

Study of clinical profile and outcome of patients with acute non-traumatic paraparesis

“…In a study conducted by Thangaraj et al, 61.33 percent of the patients were males while the remaining were females. 5,6…”

“…Thangaraj et al in their study, reported that 32 percent and 22.67 percent of the patients belonged to the age group of 40 to 50 years and 20 to 30 years respectively [5][6][7]. …”

Mielopati Non Kompresif: Pendekatan Diagnosis

“…2 Terminologi mielopati kompresif dan nonkompresif diperkenalkan oleh Siccard dan Frostier pada tahun 1921 berdasarkan pemeriksaan mielografi. 1,3 Mielopati nonkompresif didefinisikan sebagai disfungsi medula spinalis tanpa adanya bukti klinis dan radiologis kompresi medula spinalis. 3 Lesi kompresi disingkirkan dengan magnetic resonance imaging (MRI).…”

“…1,3 Mielopati nonkompresif didefinisikan sebagai disfungsi medula spinalis tanpa adanya bukti klinis dan radiologis kompresi medula spinalis. 3 Lesi kompresi disingkirkan dengan magnetic resonance imaging (MRI). [2][3][4] Penatalaksanaan mielopati sebagian besar adalah medikamentosa, sebagian kasus mielopati kompresif yang merupakan kondisi gawat darurat dengan penatalaksanaan bedah.…”

“…3 Lesi kompresi disingkirkan dengan magnetic resonance imaging (MRI). [2][3][4] Penatalaksanaan mielopati sebagian besar adalah medikamentosa, sebagian kasus mielopati kompresif yang merupakan kondisi gawat darurat dengan penatalaksanaan bedah. 5 Berdasarkan perjalanan penyakit, mielopati dapat dibagi menjadi: 6 1.…”