Myelopathy

Cui L, Locatelli L et al (1997) Effect of nucleoside analogs on neurite regeneration and mitochondrial DNA synthesis in PC-12 cells. J Pharmacol Exp Ther 280(3) 1228-1234 Dal Pan GJ, Glass JD et al (1994) Clinicopathologic correlations of HIV-l-associated vacuolar myelopathy an autopsy-based case-control study. Neurology 44(11) 2159-2164 Dalakas MC (2001) Peripheral neuropathy and antiretroviral drugs. J Peripher Nerv Syst 6(l) 14-20 Dalakas MC, Semino-Mora C et al (2001) Mitochondrial alterations with mitochondrial DNA depletion in the nerves of AIDS patients with peripheral neuropathy induced by 2 3 -dideoxycytidine (ddC). Lab Invest 81(11) 1537-1544... 

EUbott DJ, Peress N, Burger H, LaNeve D, Orensteiu J, Geudehuau HE, Seidmau R, Weiser B (1989) Humau immuuodeficieucy virus type 1 iu spiual cords of acquired immuuodeficieucy syndrome patients with myelopathy expression and replication in macrophages. Proc Natl Acad Sd U S A. 86 3337 1... 

HTLV I Endemic in W Indies and SW Japan transmission via blood, human milk can cause adult T-cell leukemia, and HTLV I-associated myelopathy and tropical spastic paraparesis... 

Myelopathy. Damage to the spinal cord results in weakness or paralysis of voluntary muscles. 

Subacute AIDS encephalitis (K3) was detected in adult and pediatric brains. Immunocytochemical analysis of adult and pediatric brains revealed gp 41 im-munoreactivity (78% and 40% respectively). Virtually all adult brains with SAE had gp 41 immunoreactivity in macrophages and microglia. Spinal cords with vacuolar myelopathy or corticospinal tract degeneration had only rare gp 41 positive cells. Brains of aborted fetuses from HIV-1 seropositive women were negative for gp 41 immunocreactivity, but some were positive for HIV-1 by polymerase chain reaction. 

Humoral Immune Response in Chronic Inflammatory Processes. The specificity of the diagnostically relevant intrathecal antibodies depends on the underlying cause of the disorder. In the case of chronic infective processes, the antibodies are exclusively targeted against the causative organism (F5). Increased IgC levels are found in about 30% of patients with chronic meningitis or encephalitis from various causes, such as bacteria, virus and protozoa, and in diseases like polyradiculitis, sarcoidosis, and chronic myelopathy (LI). 

It is indicated in spasticity due to neurological disorders e.g., multiple sclerosis, chronic myelopathy, degenerative diseases of the spinal cord, cerebrovascular accidents and cerebral palsy painful muscle spasm associated with static and functional disorders of the spine (cervical and lumbar syndromes) painful muscle spasm following surgery e.g., for herniated intervertebral disc or for osteoarthritis of the hip. 

Eilbott, D. J., Peress, N., Burger, H., LaNeve, D., Orenstein,J., Gendelman, H. E., Seidman, R., and Weiser, B. (1989). Human immunodeficiency virus type 1 in spinal cords of acquired immunodeficiency syndrome patients with myelopathy Expression and replication in macrophages. Proc. Natl Acad. Sci. USA 86, 3337-3341. 

Compared with brain ischemia spinal cord strokes are caused by more diverse etiologies. Up-to-now there is no satisfactory and accepted classification of spinal infarcts. Etiologies include circulatory arterial and venous disorders. From a clinical and pathoanatomical point of view it seems reasonable to differentiate between acute ischemic myelomalacia and subacute to chronic vascular myelopathy (Table 17.1). In most cases MRI enables the differentiation of these two main etiologies. A deficient spinal arterial blood flow generally has various causes, ranging from the occlusion of intercostal or lumbar arteries to affection of the intrinsic arteries of the spinal cord. ... 

Table 17.1. Disorders resulting in primary vascular myelopathy...

Subacute/chronic vascular myelopathy Dural AV fistula... 

Subacute or chronic vascular myelopathy is the result of disturbances of microcirculation caused by compromised venous outflow or small-vessel disease. 

In most cases congestive myelopathy takes a subacute to chronic course, although acute worsening may be observed. SDAVF is the prototype of a congestive myelopathy. The symptoms in SDAVF are slowly progressive and consist of sensory loss and paraparesis both of which reflect the extent of the cord involvement. They are independent of the location of the fistula (Koenig et al. 1989). An acute onset of the disease (11%) or a progressive development interrupted by intermediate remissions (11%) are the rare forms (Symon et al. 1984). Almost all... 

In SDAVF the key findings in MRI are the sequelae of the congestive myelopathy and the detection of the arterialized perimedullary veins (Fig. 17.10). MRI shows in almost all cases a long central intramedullary hyperintense lesion in T2-weighted images that spans several cord segments (Koch et al. 1998 Van Dijk et al. 2002). A characteristic finding is a hypointense rim adjacent to the spinal cord lesion. 

Spinal AVMs can be mainly divided into AVM of the perimedullary fistula type and glomerular type. Typically, congestive myelopathy is obvious in AVM of the perimedullary type (Heros et al. 1986 Rosenblum et al. 1987 Thron et al. 2001). 

Perimedullary fistulas type 1 may present with multisegmental hyperintensive cord lesions on T2-weighted images due to congestive myelopathy similar to spinal cord affection in spinal dural AVF. 

Hurst R.W., and Grossman RI (2000) Peripheral spinal cord hypodensity on T2-weighted MR images a reliable imaging sign of venous hypertensive myelopathy. AJNR Am J Neuroradiol 21 781-786... 

In North America and the United Kingdom, there is growing concern that many elderly subjects with mild or no anemia and normal serum B12 concentrations are suffering from preventable and correctable vitamin B12 deficiency disease. Today, in economically advanced countries, as many as 75% of vitamin B12-deficient patients present with various neurological symptoms, including somatic and autonomic neuropathies, myelopathies, cortical atrophy, and dementia (Carranza, 2002). In addition, vitamin B12-depleted subjects may develop postoperative myeloneuropathy when exposed to anesthesia... 

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