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What is new in Medicine? Part-2L.J. Basumatary. MD. Registrar, Gauhati Medical College Hospital, Guwahatidrbasumatary@gmail.com

Evaluation of Acute Transverse MyelopathyNew investigation includes neuromyelitis optica antibody (aquaporin-4)

Hypocupric MyelopathyThis recently described myelopathy is virtually identical to subacute combineddegeneration (SCD) and probably explains many cases previously described withnormal serum levels of B 12 . Low levels of serum copper are found and often thereis also a low level of serum ceruloplasmin. Some cases follow gastrointestinalprocedures that result in impaired copper absorption, but many others areidiopathic. Improvement or at least stabilization may be expected withreconstitution of copper stores by oral supplementation. The pathophysiology andpathology are not known.Rehabilitation of Spinal Cord DisordersThe prospects for recovery from an acute destructive spinal cord lesion fade after~6 months. There are currently no effective means to promote repair of injuredspinal 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 andlocal introduction of stem cells.

Expected Neurologic Function Following Complete Cord Lesions

Level Self-Care Transfers Maximum Mobility

Highquadriplegia(C1-C4)

Dependent onothers; requiresrespiratory support

Dependent onothers

Motorized wheelchair

Lowquadriplegia(C5-C8)

Partiallyindependent withadaptive equipment

May bedependent orindependent

May use manualwheelchair, drive anautomobile withadaptive equipment

Paraplegia(below T1)

Independent Independent Ambulates shortdistances with aids

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

1. Symptoms associated with medical illnessesInfections urinary tract,skin,lung, bonesThrombophlebitis, abdominal pathologyQuadriplegic fever )

2. Bladder careDetrusor spasticity ----- anticholinergic drugs (oxybutinin, 2.55 mg

qid) or TCA with anticholinergic properties(imipramine, 25200 mg/d).

Urinary dyssynergia--- -adrenergic blocking agent terazosinhydrochloride (12 mg tid or qid),Intermittent catheterization,Condom catheter in men ora permanent indwelling catheter.

Surgical treatment ------ enterocystoplasty

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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 Usubcutaneously every 12 h) or warfarin (INR, 23) are recommended.

In cases of persistent paralysis, anticoagulation should probably be continued for3 months.4. decubitus ulcers5. Spasticity ---Baclofen (15240 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 (24 mg at bedtime).Tizanidine (28 mg tid), an 2 adrenergic agonist that increases

presynaptic inhibition of motor neurons, is anotheroption.

For nonambulatory patients, the direct muscle inhibitor dantrolene (25100 mgqid) may be used, but it is potentially hepatotoxic.

In refractory cases----- intrathecal baclofenbotulinum toxin injections, ordorsal rhizotomy

6. Paroxysmal autonomic hyperreflexia --Treatment consists of removal of offending stimuli; ganglionic blocking agents (mecamylamine, 2.55 mg) or othershort-acting antihypertensive drugs is useful in some patients.

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