Acute myelopathies - Clinical, laboratory and outcome profiles in 79 cases

The main aetiologies of acute myelopathy (AM) are: multiple sclerosis, syst emic disease (SD), spinal cord infarct (SCI), parainfectious myelopathy (PE W) and delayed radiation myelopathy (DRM). Although a large amount of data have been published for each individual aetiology, comparison studies are s carce. The aim of this study was to assess the various aetiological and out come profiles of AM. We studied 79 cases: 34 (43%) in multiple sclerosis; 1 3 (16.5%) in SD; 11 (14%) in SCI; five (6%) in PIM; and three (4%) in DRM. Myelopathies were of unknown origin in 13 (16.5%) patients. We evaluated cl inical, spinal cord and brain MRI, CSF and evoked potentials data at admiss ion, MRI outcome at 6 months and clinical outcome at 12 months. A statistic al comparison of clinical, laboratory and outcome data was only performed b etween multiple sclerosis, SD and SCI patients due to the small number of c ases in the other groups. A motor deficit was more frequent in SD and SCI t han in multiple sclerosis where initial symptoms were predominantly sensory (P < 0.001). Spinal cord MRI showed lateral or posterior lesions of less t han two vertebral levels in multiple sclerosis, in contrast to SD and SCI, where lesions involved more vertebral levels and were centromedullar (P < 0 .001). Brain MRI was most frequently abnormal in multiple sclerosis (68%), but was also abnormal in 31% of SD patients (P < 0.05). Oligoclonal bands i n CSF were more frequent in multiple sclerosis than in SD (P < 0.001) and w ere never found in SCI Clinical outcome at 12 months was good in 88% of mul tiple sclerosis cases, and poor or fair in 91% of SCI and 77% of SD. Aetiol ogies of AM may be differentiated on the basis of clinical, spinal cord and brain MRI, CSF and outcome data, and allow a probable diagnosis to be made in previously undetermined cases. These findings may have therapeutic impl ications for cases with a questionable diagnosis.