Acute Non-Traumatic Paraparesis: A Comprehensive Analysis of Aetiology and Clinical Profile in an Indian Subpopulation
Acute Non-Traumatic Paraparesis
Keywords:
Tuberculosis, Acute Transverse Myelitis, Magnetic Resonance Imaging (MRI), MyelopathyAbstract
Background and Objectives: This study was performed in a tertiary care hospital in western India. Our aim was to understand and analyze the clinical profile and causes of acute non-traumatic paraparesis and correlate them with relevant biochemical and radiological investigations. Methods: 100 cases of acute non-traumatic paraparesis admitted over a period of three years were studied. Data on age, sex, presenting symptoms, clinical signs and medical investigations was analyzed critically. This study used the mean and the median as measures of central tendency and standard deviation as a measure of dispersion. Results: Incidence of acute non-traumatic paraparesis was found to be the highest in the third and fourth decade of life (36% of cases). Incidence among males (54%) and females (46%) was fairly equal. An inability to walk (72%) or a difficulty in walking (28%) were the chief presenting symptoms. 76% of cases presented in a stage of spinal shock. Tuberculosis was the commonest cause (40%), followed by acute transverse myelitis (26%). 50% of cases had compressive myelopathy while 30% had non-compressive myelopathy. Investigations such as cerebrospinal fluid (CSF) analysis, nerve conduction studies and Magnetic Resonance Imaging (MRI) were useful in diagnosing the causes. Conclusion: The commonest cause of acute non-traumatic paraparesis was tuberculosis. Early use of the MRI scan helps to confirm etiology and site of lesion. [Vaishnav B NJIRM 2014; 5(5):17-21]
References
2. Nene A, Bhojraj S. Results of nonsurgical treatment of thoracic spinal tuberculosis in adults. Spine (Phila Pa 1976) 2005; 1: 79-84.
3. Moon, MS. Tuberculosis of the Spine: Controversies and a New Challenge. Spine (Phila Pa 1976) 1997; 15: 1791-1797.
4. Chaurasia RN, Verma A, Joshi D, Misra S. Etiological Spectrum of Non-traumatic Myelopathies: Experience from a Tertiary Care Centre. J Assoc Physicians India 2006; 6: 445-448.
5. Scrimgeour EM. Non-traumatic paraplegia in northern Tanzania. Br Med J (Clin Res Ed) 1981; 10: 975-978.
6. Owolabi LF, Ibrahim A, Samaila AA. Profile and outcome of non-traumatic paraplegia in Kano, northwestern Nigeria. Ann Afr Med 2011; 2: 86-90.
7. Parry O, Bhebhe E, Levy LF. Non-traumatic paraplegia in a Zimbabwean population – a retrospective survey. Cent Afr J Med 1999; 5: 114-119.
8. Joseffer SS, Cooper PR. Modern imaging of spinal tuberculosis. J Neurosurg Spine 2005; 2: 145-150.
9. Lu CH, Chang WN, Lui CC, Lee PY, Chang HW. Adult spinal epidural abscess: clinical features and prognostic factors. Clin Neurol Neurosurg 2002; 4: 306-310.
10. Harzheim M, Schlegel U, Urbach H, Klockgether T, Schmidt S. Discriminatory features of acute transverse myelitis: a retrospective analysis of 45 patients. J Neurol Sci 2004; 2: 217-223.
11. Sakakibara R, Hattori T, Yasuda K, Yamanishi T. Micturition disturbance in acute transverse myelitis. Spinal Cord 1996; 8: 481-485.
12. Tartaglino LM, Croul SE, Flanders AE, Sweeney JD, Schwartzman RJ, Liem M, et al. Idiopathic acute transverse myelitis: MR imaging findings. Radiology 1996; 3: 661-669.
13. Masaryk TJ. Neoplastic disease of the spine. Radiol Clin North Am 1991; 4: 829-845.
14. Bach F, Larsen BH, Rohde K, Borgesen SE, Gjerris F, Boge-Rasmussen T, et al. Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression. Acta Neurochir (Wien) 1990; 1-2: 37-43.
15. Vapalahti M, Kuurne T. Acute paraplegia caused by a spontaneous extradural hematoma of the conus medullaris area. Acta Chir Scand. 1975; 6: 484-487.
16. Alexiadou-Rudolf C, Ernestus RI, Nanassis K, Lanfermann H, Klug N. Acute Nontraumatic Spinal Epidural Hematomas: An Important Differential Diagnosis in Spinal Emergencies. Spine (Phila Pa 1976) 1998; 16: 1810-1813.
