Funicular myelosis

Funicular myelosis

Symptoms, course. Paresthesias gradually appear in the feet, then violations of deep sensitivity, sensory ataxia and weakness in the legs are added. Depending on the degree of the disorder of the joint-muscular sense, the paresis in the legs may be either spastic or lethargic. Tendon reflexes are initially elevated, but as the disease progresses die out. Constantly detect stop pathological reflexes (Babinsky and others). The combination of pyramidal symptoms with flaccid paresis is a characteristic feature of the disease. Sensitive and motor disorders are accompanied by violations of the functions of the pelvic organs. Often funicular myelosis is combined with B12-deficient polyneuropathy, when the peripheral nerves are involved in the process. Typical forms are characterized by a combination of sensory ataxia and paraplegia (atactic paraplegia). In a number of cases, apathy, drowsiness, emotional lability, depression develop. Along with the usual, gradual development of the disease, acute development of neurological disorders is sometimes observed, in which a pattern of transverse spinal cord lesion with lower paraplegia, paranesthesia, and pelvic disorders occurs within 2-3 weeks. Currently, due to the widespread use of vitamin B12, at least half of cases of funicular myelosis occur atypically.

The diagnosis in the presence of pernicious anemia does not present difficulties. To differentiate in the first place follows with B12-deficient polyneuropathy, which is observed in approximately 40% of patients with pernicious anemia. The decisive differential-diagnostic sign is the defeat of the pyramidal system, indicating funicular myelosis. The main difficulties of diagnosis occur in cases where neurologic symptoms develop before the onset of anemia. The diagnosis of funicular myelosis is confirmed by the discovery of achilic gastritis and megaloblasts in the sternal punctate. The disease may resemble the spinal cord, but for the latter, Argyle Robertson's syndrome and positive serological tests for syphilis in the blood and cerebrospinal fluid are almost mandatory. With multiple sclerosis, as a rule, there is a multifaceted symptomatology, as well as a remitting course of the disease.

Combined lesion of the posterior and lateral fascicles is observed with compression lesions of the spinal cord (tumors, vertebrogenic cervical myelopathy). The diagnosis is made by detecting protein-cell dissociation in lumbar puncture and block in myelography. An important criterion for the diagnosis of funicular myelosis is the symmetry of neurological defects.

Treatment. Begin with intravenous injection of 500-1000 μg of vitamin B daily. After 5 injections, the dose is reduced to 100 μg once a week for six months. Supportive therapy - 100 mcg of vitamin B12 once a month. The administration of folic acid in a dose of 5-15 mg / day is permissible only with the very rarely detected form of funicular myelosis - folic-deficient, since otherwise folic acid causes an exacerbation of the disease.

Treatment, started a few weeks after the appearance of spinal symptoms, usually leads to recovery; With delayed treatment, there is an improvement or stabilization of the process. The main regress of symptoms is observed in the first 3-6 months of treatment.