The prognosis of acute and subacute transverse myelopathy based on early signs and symptoms
The prognosis of acute and subacute transverse myelopathy based on early signs and symptoms
复制标题
基于早期体征和症状的急性和亚急性横贯性脊髓病的预后
作者：
A. Ropper;D. Poskanzer
1955年至1975年间，马萨诸塞州总医院对52例急性和亚急性横贯脊髓病（TM）患者进行了评估，随访1至23年（平均5年）。19人最近有急性传染病的症状，3人患有癌症，1人最近做过手术。最初的症状有四种。24例患者在发病时有感觉异常，18例有疼痛，通常是肩胛间疼痛，7例有腿无力，3例有尿潴留。预后取决于TM发病的性质。急性灾难性发作通常与背部疼痛有关，11例患者中有7例预后不良，仅有1例预后良好。亚急性进行性发作持续数天至四周，通常伴有上升的感觉异常或腿部无力，37例患者中有15例预后良好，17例预后一般。既往发热性疾病、皮质类固醇治疗和脑脊液异常的性质对结果没有影响。7例患者在随访期间发展为多发性硬化症。由于肿块病变的频率被遗漏，髓系造影在TM诊断中的必要性被强调。
Fifty‐two patients with acute and subacute transverse myelopathy (TM) were evaluated at the Massachusetts General Hospital between 1955 and 1975 and followed for 1 to 23 years (average, 5). Nineteen had symptoms of a recent acute infectious illness, 3 had cancer, and 1 had undergone a recent operation. There were four types of initial symptom. Twenty‐four patients had paresthesias at the onset of the illness, 18 had pain, usually interscapular, 7 had leg weakness, and 3 had urine retention. Prognosis depended on the nature of the onset of TM. An acute catastrophic onset was generally associated with back pain and led to a poor outcome in 7 and a good outcome in only 1 of 11 patients. A subacute progressive onset over several days to four weeks, generally with ascending paresthesias or leg weakness, was associated with a good outcome in 15 and fair outcome in 17 of 37 patients. Preceding febrile illness, treatment with corticosteroids, and the nature of CSF abnormalities had no effect on outcome. Multiple sclerosis evolved in 7 patients during the follow‐up period. Because of the frequency with which mass lesions were missed, the need for myelography in the diagnosis of TM is emphasized.