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[Myelopathies in a context of generalized infection: myelitis or compression?]
Abstract:
Four patients with rapidly progressive tetraparesis in relation with skin or joint infection and septicemia are reviewed. Clinical signs of medullary compression was present in all cases, confirmed by neuroradiological examinations. However, all surgical approaches failed to demonstrate clear evidence of compression. Within three weeks, the neurological picture of severe tetraparesis had an excellent clinical evolution in all cases. One of the patients died after developing pulmonary complications: necropsy did not show any signs of compression. The difficulty of differential diagnosis between an infectious compressive surgical pathology and an inflammatory disease (acute transverse myelitis type) is emphasized, with review of literature.
Insights
Rapidly progressive tetraparesis associated with infection resolved spontaneously in four patients, despite initial signs suggesting spinal cord compression. This highlights the challenge in differentiating infectious compressive pathology from inflammatory conditions like acute transverse myelitis.
Area of Science:
- Neurology
- Infectious Diseases
- Spinal Cord Pathology
Background:
- Rapidly progressive tetraparesis can be a neurological emergency requiring prompt diagnosis.
- Infectious processes, including septicemia, can lead to severe neurological deficits.
- Spinal cord compression is a primary concern in patients presenting with acute tetraparesis.
Observation:
- Four patients presented with tetraparesis linked to skin/joint infections and septicemia.
- Clinical and neuroradiological findings suggested medullary compression in all cases.
- Surgical exploration did not reveal definitive evidence of compression.
Findings:
- All patients showed significant neurological improvement within three weeks, resolving severe tetraparesis.
- One patient died from pulmonary complications; necropsy excluded spinal cord compression.
- The clinical course was favorable, contrasting with initial diagnostic impressions.
Implications:
- Distinguishing between infectious compressive spinal pathology and inflammatory myelitis is clinically challenging.
- This case series underscores the importance of considering non-compressive inflammatory conditions.
- Further research is needed to refine diagnostic strategies for acute myelopathies in septic patients.