What is new in Medicine?

Part-2
L.J. Basumatary. MD. Registrar, Gauhati Medical College Hospital, Guwahati
drbasumatary@gmail.com

Evaluation of Acute Transverse Myelopathy

New investigation includes neuromyelitis optica antibody (aquaporin-4)

Hypocupric Myelopathy
This recently described myelopathy is virtually identical to subacute combined
degeneration (SCD) and probably explains many cases previously described with
normal serum levels of B12. Low levels of serum copper are found and often there
is also a low level of serum ceruloplasmin. Some cases follow gastrointestinal
procedures that result in impaired copper absorption, but many others are
idiopathic. Improvement or at least stabilization may be expected with
reconstitution of copper stores by oral supplementation. The pathophysiology and
pathology are not known.
Rehabilitation of Spinal Cord Disorders
The prospects for recovery from an acute destructive spinal cord lesion fade after
~6 months. There are currently no effective means to promote repair of injured
spinal cord tissue; promising experimental approaches include --

The use of factors that influence reinnervation by axons of the corticospinal tract,
Nerve and neural sheath graft bridges and
local introduction of stem cells.

Expected Neurologic Function Following Complete Cord Lesions

Level Self-Care Transfers Maximum Mobility

High Dependent on Dependent on Motorized wheelchair
quadriplegia others; requires others
(C1-C4) respiratory support
Low Partially May be May use manual
quadriplegia independent with dependent or wheelchair, drive an
(C5-C8) adaptive equipment independent automobile with
adaptive equipment
Paraplegia Independent Independent Ambulates short
(below T1) distances with aids

Source: JF Ditunno, CS Formal: Chronic spinal cord injury. N Engl J Med 330:550, 1994

1. Symptoms associated with medical illnesses

Infections – urinary tract,skin,lung, bones
Thrombophlebitis, abdominal pathology
Quadriplegic fever)
2. Bladder care
Detrusor spasticity ----- anticholinergic drugs (oxybutinin, 2.5–5 mg
qid) or TCA with anticholinergic properties
(imipramine, 25–200 mg/d).
Urinary dyssynergia--- ∝-adrenergic blocking agent terazosin
hydrochloride (1–2 mg tid or qid),
Intermittent catheterization,
Condom catheter in men or
a permanent indwelling catheter.
Surgical treatment ------ enterocystoplasty
 Urinary conduit.
Bladder areflexia due to acute spinal shock or conus lesions -----
catheterization.
Bowel regimens and disimpaction

3. venous thrombosis and pulmonary embolism-----During the first 2 weeks,

use of calf-compression devices and anticoagulation with heparin (5000 U
subcutaneously every 12 h) or warfarin (INR, 2–3) are recommended.

In cases of persistent paralysis, anticoagulation should probably be continued for

3 months.
4.decubitus ulcers
5.Spasticity---Baclofen (15–240 mg/d in divided doses) , it acts by facilitating
GABA-mediated inhibition of motor reflex arcs.
Diazepam acts by a similar mechanism and is useful for leg
spasms that interrupt sleep (2–4 mg at bedtime).
Tizanidine (2–8 mg tid), an ∝2 adrenergic agonist that increases
presynaptic inhibition of motor neurons, is another
option.
For nonambulatory patients, the direct muscle inhibitor dantrolene (25–100 mg
qid) may be used, but it is potentially hepatotoxic.

In refractory cases----- intrathecal baclofen

botulinum toxin injections, or
dorsal rhizotomy
6.Paroxysmal autonomic hyperreflexia--Treatment consists of removal of
offending stimuli; ganglionic blocking agents (mecamylamine, 2.5–5 mg) or other
short-acting antihypertensive drugs is useful in some patients.

--------------------------------------------------------------- To be continued