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[Acute non-traumatic myelopathy in children and adolescents].

Abstract：

:The term 'acute myelopathies'--referred to a spinal cord dysfunction--represent a heterogeneous group of disorders with distinct etiologies, clinical and radiologic features, and prognoses. The objective of this review is to discuss the non-traumatic acute myelopathies. Acute myelopathy can be due to several causes as infective agents or inflammatory processes, such as in acute myelitis, compressive lesions, vascular lesions, etc. The clinical presentation is often dramatic with tetraparesis or paraparesis, sensory disturbances and bladder and/or bowel dysfunction. History and physical examination are used to localize the lesion to the root or specific level of the cord, which can guide imaging. Different syndromes are recognized: complete transverse lesion, central grey matter syndrome, anterior horn syndrome, anterior spinal artery syndrome, etc). The first priority is to rule out a compressive lesion. If a myelopathy is suspected, a gadolinium-enhanced MRI of the spinal cord should be obtained as soon as possible. If there is no structural lesion such as epidural blood or a spinal mass, then the presence or absence of spinal cord inflammation should be documented with a lumbar puncture. The absence of pleocytosis would lead to consideration of non inflammatory causes of myelopathy such as arteriovenous malformations, fibrocartilaginous embolism, or possibly early inflammatory myelopathy. In the presence of an inflammatory process (defined by gadolinium enhancement, cerebrospinal fluid pleocytosis, or elevated cerebrospinal fluid immunoglobulin index), one should determine whether there is an inflammatory or an infectious cause. Different virus, bacterias, parasites and fungi have to be considered as autoimmune and inflammatory diseases that involve the central nervous system. TITLE:Mielopatias agudas no traumaticas en niños y adolescentes. :El termino 'mielopatias agudas' se refiere a una disfuncion de la medula espinal y representa un grupo heterogeneo de trastornos con distintas etiologias y caracteristicas clinicas (imaginologicas y de pronostico). El objetivo de esta revision es tratar las mielopatias agudas no traumaticas. La mielopatia aguda puede deberse a varias causas, como agentes infecciosos o procesos inflamatorios, compresion y lesiones vasculares, entre otros. La presentacion clinica es a menudo dramatica con tetraparesia o paraparesia, alteraciones sensitivas y disfuncion de la vejiga o del intestino. La historia y el examen fisico se utilizan para localizar la lesion o el nivel especifico de la medula, que puede guiar la solicitud de la imagen. La primera prioridad es descartar una lesion compresiva. Si se sospecha una mielopatia, debe obtenerse tan pronto como sea posible una resonancia magnetica medular con gadolinio. Si no hay ninguna lesion estructural, entonces la presencia o ausencia de inflamacion de la medula espinal debe documentarse con una puncion lumbar. La ausencia de pleocitosis daria lugar a la consideracion de causas no inflamatorias como malformaciones arteriovenosas, embolia fibrocartilaginosa o posiblemente el inicio de una mielopatia inflamatoria. En presencia de un proceso inflamatorio (realce con gadolinio, pleocitosis o elevado indice de inmunoglobulina en el liquido cefalorraquideo), se debera determinar si hay una inflamacion o una causa infecciosa. Se tienen que considerar hongos, bacterias, parasitos y virus, asi como enfermedades autoinmunes e inflamatorias que involucran al sistema nervioso central.

journal_name

Rev Neurol

journal_title

Revista de neurologia

authors

Arroyo HA

subject

Has Abstract

pub_date

2013-09-06 00:00:00

pages

S129-38

eissn

0210-0010

issn

1576-6578

pii

rn2013306

journal_volume

57 Suppl 1

pub_type

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[Acute non-traumatic myelopathy in children and adolescents].