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Venous hypertensive myelopathy as a potential mimic of transverse myelitis
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KRISHNAN C; MALIK J; KERR DA
SPINAL CORD , 2004, vol. 42, n° 4, p. 261-264 Doc n°: 113690 Localisation : Centre de Réadaptation de Lay St Christophe , en ligne Descripteurs : AE4 - SYRINGOMYELIE ET MALFORMATIONS DE LA MOELLE Url : http://www.nature.com/sc/archive/index.html We describe a patient who developed a myelopathy associated with a noncompressive herniated cervical intervertebral disc at the same level. We provide clinical and radiological evidence that reveals that even though the disc herniation did not compress the spinal cord, it diminished venous blood flow out of the spinal cord, possibly resulting in a venous hypertensive myelopathy (VHM). Setting: Baltimore, MD, USA. Clinical presentation: A 29-year-old woman developed a cervical radiculopathy, followed by a slowly progressive cervical myelopathy associated with a herniated C5-C6 disc. Magnetic resonance imaging showed a noncompressive disc herniation, a swollen spinal cord with increased T2 signal most prominent at the site of the herniated disc, extending several levels above and below the disc. The patient was diagnosed with acute transverse myelitis (ATM) and was started on IV steroids. However, unlike most cases of transverse myelitis, spinal fluid analysis was noninflammatory. In contrast, several features suggested that the patient instead had VHM. We suggest that the disc herniation resulted in impaired drainage of blood from the spinal cord through compression of the venous plexus near the intervertebral foramen. Intervention: Although the patient did not recover function following high-dose steroid administration, she recovered completely following C5 - C6 discectomy and fusion. Conclusion: To our knowledge, this is the first report of likely VHM in the absence of a spinal arteriovenous malformation. Langue : ANGLAIS |
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