A PROSPECTIVE SURVEY OF THE CAUSES OF NONTRAUMATIC SPASTIC PARAPARESIS AND TETRAPARESIS IN 585 PATIENTS

Objective: To ascertain the relative frequencies of the causes of non- traumatic paraparesis and tetraparesis in adults. Design: Survey of pa tients enrolled prospectively over a 3 year period between 1986 and 19 89 and review of their case notes 1 year after enrollment ceased (mean duration of follow up 30 months). Setting: Regional neurosciences cen tre in the UK serving over three million people in Merseyside and Nort h Wales. Patients: Experienced clinicians from the centre saw most pat ients in the region with non-traumatic spastic paraparesis or tetrapar esis. Primary investigation of patients was by myelography, for which patients were admitted to the centre. 585 consecutive patients with sp astic paraparesis or tetraparesis were identified by daily screening o f all 2104 patients undergoing myelography or radiculography during th e 3 year period, ie selection by the intention to investigate them for myelopathy. Exclusions: age under 15 years, previous myelography for myelopathy. Interventions: None. Main outcome measures: Numbers and pr oportions of patients with each condition or category of disease. Resu lts: Commonest diagnoses were cervical spondylotic myelopathy (23.6%), extrinsic neoplastic or developmental tumour (16.4%), multiple sclero sis (9.1% rising to 17.8% after MRI of a selected group), and motor ne urone disease (4.1%). Diagnosis was uncertain in 27.4%, falling to 18. 6% after MRI. Conclusions: This survey shows the pattern of diseases p roducing non-traumatic myelopathy in the Mersey Region and in North Wa les. Changing patterns of referral, investigation in peripheral hospit als and by non neurologically trained practitioners, and increasing us e of outpatient MRI for primary investigation may make comparable surv eys impossible in the future.