published_or_final_version / Pathology / Master / Master of Medical Sciences

published_or_final_version / Medicine / Master / Master of Medical Sciences

published_or_final_version / Orthopaedics and Traumatology / Master / Master of Philosophy

Acute and subacute diseases causing intrinsic spinal cord damage are confusing and poorly defined clinically and pathologically. of this study is: The purpose 1. To analyse the spectrum of conditions responsible for acute and subacute myelopathy in South Africa. 2. To categorise the clinical presentations and prognosis of the illnesses and to correlate these with aetiology. 3. To assess the validity of diagnostic criteria for acute and subacute myelopathy in general and for the different aetiological groups. 4. To review the literature and to correlate previous studies with the present one. Thirty-four patients fulfilling strict criteria nave been identified over a seven-and-a-half-year period using the Groote Schuur Hospital computer retrieval system. Although the study was essentially retrospective, 11 of these patients were seen personally during their acute illnesses. All these patients have suffered from illnesses causing spinal cord dysfunction in the absence of trauma, physical agents or any extrinsic pressure such as might be caused by tumours or spondylosis. Maximum disability was reached in less than 8 weeks. In 17 patients no cause was identified. The clinical features, laboratory findings and courses have been analysed. Among the results, a high percentage of patients with Brown-Sequard Syndromes were found with possible significance for the pathogenesis of the illness. Seven patients with meningovascular syphilis were analysed as well as 2 additional patients with spinal cord syphilis not fulfilling the strict criteria of the study. Although well known before the penicillin era, this entity is not well described in modern neurological literature. Four patients had myelopathy associated with pulmonary tuberculosis in the absence of tuberculous meningitis or spinal disease. Three of these 4 patients also developed optic neuropathy. The association of these conditions has previously been described in only a very few patients. Two patients had Epstein-Barr virus infections and 1 had an infection with Mycoplasma pneumoniae. Two had systemic lupus erythematosus and 1 had an acute cord infarct following an aortic aneurysm repair. The literature is reviewed and the findings of this study correlated with previous ones. Conclusions regarding terminology, criteria for diagnosis, investigations, course and prognosis are discussed.

Law Ka Pui, Karlen. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 159-170). / Abstracts in English and Chinese. / Declaration --- p.1 / Abstract --- p.ii / Acknowledgement --- p.vii / Abbreviations --- p.viii / List of Figures --- p.x / List of Tables --- p.xiv / Contents --- p.xvi / Chapter Chapter One - --- Introduction / Chapter 1.1 --- The Cervical Spine / Chapter 1.1.1 --- Anatomy of Typical Cervical Vertebrae --- p.1 / Chapter 1.1.1.1 --- The Vertebral Body / Chapter 1.1.1.2 --- The Vertebral (Neural) Arch / Chapter 1.1.1.3 --- The Vertebral Processes / Chapter 1.1.1.4 --- The Foramina / Chapter 1.1.2 --- Anatomy of Atypical Cervical Vertebrae --- p.6 / Chapter 1.1.3 --- The Cervical Region of Spinal Cord --- p.8 / Chapter 1.1.3.1 --- Structure of the Spinal Cord / Chapter 1.1.3.1.1 --- Gray Matter / Chapter 1.1.3.1.2 --- White Matter / Chapter 1.1.4 --- The Crucial Ascending Tracts in the White Column --- p.11 / Chapter 1.1.4.1 --- Tracts in Dorsal (Posterior) Column / Chapter 1.1.4.2 --- Tracts in the Lateral Column / Chapter 1.1.4.2.1 --- Posterior Spinocerebellar Tract / Chapter 1.1.4.2.2 --- Anterior Spinocerebellar Tract / Chapter 1.1.4.2.3 --- Lateral Spinothalamic Tract / Chapter 1.1.4.2.4 --- Postero-lateral Tract of Lissauer / Chapter 1.1.4.2.5 --- Spino-olivary Tract / Chapter 1.1.4.3 --- Tracts in the Ventral (Anterior) Column / Chapter 1.1.5 --- The Main Descending Tracts of White Column --- p.14 / Chapter 1.1.5.1 --- Tracts in the Dorsal Column / Chapter 1.1.5.2 --- Tracts in the Lateral Column / Chapter 1.1.5.2.1 --- Lateral Corticospinal Tract / Chapter 1.1.5.2.2 --- Rubrospinal Tract / Chapter 1.1.5.3 --- Tracts in Ventral Column / Chapter 1.1.5.3.1 --- Anterior Corticospinal Tract / Chapter 1.1.5.3.2 --- Vestibulospinal Tract and Reticulospinal Tract / Chapter 1.2 --- The Cervical Spinal Nerve Roots / Chapter 1.2.1 --- The Dorsal Roots --- p.16 / Chapter 1.2.2 --- The Ventral Roots --- p.18 / Chapter 1.2.3 --- The Relation between the Afferent and Efferent Nerve Roots --- p.19 / Chapter 1.3 --- Cervical Myelopathy / Chapter 1.3.1 --- Cause of Cervical Spondylotic Myelopathy --- p.21 / Chapter 1.3.2 --- Clinical Symptoms of Cervical Myelopathy --- p.23 / Chapter 1.4 --- Hypothesis --- p.25 / Chapter Chapter Two - --- Methodology / Chapter 2.1 --- Inclusive Criteria of the Study --- p.27 / Chapter 2.2 --- Magnetic Resonance Imaging of the Cervical Spine --- p.29 / Chapter 2.2.1 --- The Setup of the MRI / Chapter 2.2.2 --- Subject Preparation / Chapter 2.2.3 --- Identification of the Most Stenotic Region in the Cervical Spine / Chapter 2.2.4 --- Measurement of the Most Stenotic Cervical Spinal Cord and Canal / Chapter 2.2.4.1 --- Dimensions of the Spinal Cord and Canal in Sagittal Plane / Chapter 2.2.4.2 --- Dimensions of the Spinal Cord and Canal in Coronal Plane / Chapter 2.2.4.3 --- Dimensions of the Spinal Cord and Canal in Horizontal Plane / Chapter 2.2.4.4 --- Compression Ratio of the Sagittal and Coronal Dimension / Chapter 2.2.5 --- Somatosensory Evoked Potential (SEP) Evaluation / Chapter 2.2.6 --- Choice of Stimulation / Chapter 2.2.7 --- Reception of Signals / Chapter 2.2.7.1 --- Erb's Point / Chapter 2.2.7.2 --- Sensory Cortex Reception / Chapter 2.2.7.3 --- Subject Preparation / Chapter 2.3 --- Upper Limb Functional Assessment --- p.44 / Chapter 2.3.1 --- JOA Score for Cervical Myelopathy / Chapter 2.3.1.1 --- Upper Extremity Function / Chapter 2.3.1.2 --- Lower Extremity Function / Chapter 2.3.1.3 --- Sensory Disturbance / Chapter 2.3.1.4 --- Urinary Function / Chapter 2.3.2 --- Jebsen Hand Function Test / Chapter 2.3.2.1 --- Sub-test 2 - Card Turning Test / Chapter 2.3.2.2 --- Sub-test 3 - Small Object Pinching Test / Chapter 2.3.2.3 --- Sub-test 4 - Simulated Feeding Test / Chapter 2.3.2.4 --- Sub-test 5 - Stacking Checkers Test / Chapter 2.3.2.5 --- Sub-test 6 - Large Light Object Picking Test / Chapter 2.3.2.6 --- Sub-test 7 - Heavy Large Object Picking Test / Chapter 2.3.3 --- The Purdue Pegboard Test / Chapter 2.3.3.1 --- Sub-test 1 - Dominant Hand / Chapter 2.3.3.2 --- Sub-test 2 - Non-dominant Hand / Chapter 2.3.3.3 --- Sub-test 3 - Both Hands / Chapter 2.3.3.4 --- Sub-test 4 - Assembly / Chapter 2.4 --- Statistical Analysis Method --- p.74 / Chapter Chapter Three - --- Results / Chapter 3.1 --- Subject Distribution --- p.76 / Chapter 3.2 --- Magnetic Resonance Imaging Measurement --- p.82 / Chapter 3.3 --- Somatosensory Evoked Potentials Recording --- p.94 / Chapter 3.4 --- JOA (Cervical) Scoring --- p.96 / Chapter 3.5 --- Jebsen Hand Function Test Measurement --- p.101 / Chapter 3.6 --- Purdue Pegboard Test Measurement --- p.105 / Chapter 3.7 --- Statistical Analysis Findings --- p.107 / Chapter 3.8 --- Summary --- p.132 / Chapter Chapter Four - --- Discussion / Chapter 4.1 --- Magnetic Resonance Imaging Measurement --- p.134 / Chapter 4.1.1 --- Cervical Myelopathy Subjects has Small Spinal Cord and Canal / Chapter 4.2 --- Somatosensory Evoked Potential of the Median Nerve --- p.140 / Chapter 4.2.1 --- The Latencies were Preserved in Most of the Subjects / Chapter 4.3 --- Cervical Cord Compression Affects the Hand Function Significantly --- p.143 / Chapter 4.3.1 --- Fine Finger Dexterity Deficiency is a Significant Clinical Symptoms of Cervical Myelopathy Subjects / Chapter 4.3.2 --- Deficiency in Manual Dexterity is another Significant Clinical Symptoms of Cervical Myelopathy Subjects / Chapter Chapter Five - --- Summary and Conclusion --- p.153 / Chapter Chapter Six - --- Further Studies / Chapter 6.1 --- Modification in the Sample Recruitment --- p.157 / Chapter 6.2 --- Modification in Assessment Tools and Procedures --- p.158 / Bibliography --- p.159