Etiological profile of noncompressive myelopathies in a tertiary care hospital of Northeast India

Abstract

Background:The discovery of antibodies against aquaporin-4 and evolving concepts of noncompressive myelopathies in the 21st century have made a major impact on the etiological profile of these diseases, with few cases turning out to be idiopathic.Objective:To find causes of noncompressive myelopathy in a tertiary care hospital of Northeast India.Materials and Methods:An observational study was carried out in the Neurology Department of Gauhati Medical College, Guwahati, from September 2013 to February 2016. Patients of noncompressive myelopathies who underwent magnetic resonance imaging (MRI) of the spine were segregated into two categories: acute-to-subacute myelopathy (ASM) and chronic myelopathy (CM). In addition to routine blood tests, chest X-ray, urinalysis, and visual evoked potentials, investigations included MRI of the brain, cerebrospinal fluid analysis, and immunological, infectious, and metabolic profile based on the pattern of involvement.Results:The study had 151 patients (96 ASM and 55 CM) with a median age of 35 years and male: female ratio 1.4:1. The causes of ASM were neuromyelitis optica spectrum disorder (23), multiple sclerosis (MS) (8), systemic lupus erythematosus (1), Hashimoto's disease (1), postinfectious acute disseminated encephalomyelitis (6), postinfectious myelitis (8), infections (9), spinal cord infarct (5), and electrocution (1). The causes of CM were MS (1), probable or possible sarcoidosis (7), mixed connective tissue disease (1), Hashimoto's disease (2), infections (9), Vitamin B12 deficiency (4), folate deficiency (2), hepatic myelopathy (2), radiation (11), and paraneoplastic (1). No etiology could be found in 48 (31.8%) patients (34 ASM and 14 CM). In 21/96 (21.9%) patients of ASM, acute transverse myelitis was idiopathic based on current diagnostic criteria.Conclusion:Underlying etiology (demyelinating, autoimmune, infectious, vascular, metabolic disorder, or physical agent) was found in 68% patients of noncompressive myelopathy.

Etiological and Radiological Spectrum of Longitudinal Myelitis: A Hospital-Based Study in North East India

“…Another study conducted in North East India which included 151 patients of noncompressive myelopathy with 35 years as their median age and a sex ratio of 1.4:1 showing a male predominance. 14 In the present series, 28 years was our median age with a sex ratio of 1:2 showing a female predominance. Similar age and gender profile were observed in other previous studies.…”

“…Another study concluded acute myelitis in 66.3% and chronic myelitis in 33.6% among their group study of 151 patients of noncompressive myelopathy. 14 In the present series, paraparesis (84%) was the most common clinical manifestation, with acute presentation in 40%, subacute in 31%, and chronic in 28% of patients. The most common location among the diagnosed case was cervico-dorsal cord (12 patients), cervical (5 patients), dorsal (4 patients), and dorsolumbar in 3, with the entire cord involvement in 2 patients.…”

“…Other were infectious causes, metabolic, PIM, radiation myelitis, AV dural fistula, ADEM, paraneoplastic, autoimmune, and unknown in 24 patients. 14 Pandey et al noted in their series of ATM that idiopathic was the most common etiology seen in 61.25%. The next major group of disorders was NMOSD and others were MS, infectious myelitis, and post-infectious case.…”

NMR Spectroscopy in Diagnosis and Monitoring of Methylmalonic and Propionic Acidemias

“…Kayal et al [95] performed a study aiming to establish the cause of several noncompressive myelopathies in a tertiary care hospital in India. Thus, 55 patients with non-compressive myelopathies were diagnosed, after the MRI of their spine, with chronic myelopathy (CM).…”

“…The causes of vitamin B 12 deficiency were determined to be combinations of a strict vegetarian diet, malnutrition, alcohol consumption, and phenytoin therapy. Although MRS was mentioned as a performed analysis, no details have been given and only MRI details and images have been presented [95].…”