Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Mar 2006
ReviewOn the coincidence of cervical spondylosis and multiple sclerosis.
Multiple sclerosis (MS) and cervical spondylosis are relatively common diseases. It is therefore inevitable that the MS clinician will be confronted with patients with myelopathy in whom the two conditions coexist. When faced with an MS patient who has cord compression secondary to cervical spondylosis as well as cord demyelination, the issue of surgical decompression of the cord arises. ⋯ There is little prospective evidence-based support for the notion of surgical cord decompression in cervical spondylosis without MS, and none at all for surgery in MS, with only small published retrospective series available. The clinician must therefore make a judgment-based treatment decision. Guidelines for the management of patients with coincidental cervical cord compression and MS are suggested.
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The clinical and paraclinical characteristics of acute transverse myelitis (ATM) were analyzed in 31 patients. In some patients there was clinical evidence of complete transection, in others of only partial lesions. Magnetic resonance imaging (MRI) in the acute phase in the first group was normal, but showed cord atrophy subsequently. ⋯ In the patients with circumscribed demyelinating lesions, the symptoms and MRI were suggestive of clinically isolated syndromes (CIS) predictive of multiple sclerosis (MS). Extensive demyelination was indicative of acute disseminated encephalomyelitis (ADEM) due to hyperergic vasculopathy or various forms of chronic vasculitis. In two patients with variable clinical symptoms, a vascular malformation was the cause of the clinical presentation, and in one patient demyelination was due to the disc compression.