Electrodiagnosis in spinal cord injured persons with new weakness or sensory loss: Central and peripheral etiologies

Objective: To assess the prevalence and causes of late neurologic decline o f persons with spinal cord injury (SCI). Design: Retrospective review of persons with SCI over a 9-year period. Thos e with complaints of new weakness or sensory loss were grouped into three c ategories based on clinical examination, electrodiagnosis, and imaging: (1) central pathology (ie, brain, spinal cord, or nerve root); (2) peripheral pathology (plexus or peripheral nerve); or (3) no identifiable etiology. Th e specific diagnoses of late neurologic decline were identified. Setting: Regional Veterans Affairs Spinal Cord Injury Service. Patients: Five hundred two inpatient and outpatient adults with SCI. Results: Nineteen percent of the study population complained of new weaknes s and/or sensory loss. Neurologic abnormalities were noted in 13.5%, 7.2% w ith central and 6.4% with peripheral causes. The most common pathologies we re posttraumatic syringomyelia (2.4%) and cervical (1.6%) and lumbosacral ( 1.2%) myelopathy/radiculopathy. A specific etiology was not determined in 6 cases (1.6%). Peripheral involvement was mostly from ulnar nerve entrapmen t (3.4%) and carpal tunnel syndrome (3.0%). Conclusions: Late-onset neurologic decline is common after SCI and can resu lt from central or peripheral pathology. Regular neurologic monitoring of S CI patients is recommended, since many with neurologic decline respond favo rably if diagnosed and treated early.