[Necrotic myelopathies and neoplastic pathologie. Three clinico-pathological cases (author's transl)]

Three clinico-pathological cases of necrotic myelopathies with a distant malignancy are presented. Two cases had a lymphosarcoma and one case a prostatic carcinoma. They were compared to 13 well studied other cases collected in the literature. These myelopathies were related to solid visceral tumours in 8 cases and to lymphomas in 5 cases. The disease could be individualized on clinical grounds (flaccid paraplegia with bladder and bowell incontinence and sensory loss without clear-cut upper boundary developing over a few weeks with normal CSF and fast impairement of general condition), and, on pathological features. It is characterized by one or several spinal cord necrosis areas, often asymetrical, involving mostly white matter, without any vascular topography. Axons are involved as well as myelin sheats. There is mild inflammation and no specific vascular alteration. There is no metastases in the cord, meninges, vertebral column or nerve root. No vascular occlusion is found. The mechanism of the disease is unknown. The frequent occurence of lymphomas could suggest the presence of immunopathological factors.