Symptomatic noncompressive motoromyelopathy presents as early manifestation in ankylosing spondylitis |
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Authors: | Wei-Hsi Chen Hsin-Ling Yin Hung-Sheng Lin Chung-Jen Chen |
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Institution: | (1) Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center and College of Medicine, Chang Gung University, 123 Tai Pei Road, Niao Sung Hsiang, Kaohsiung, 833, Taiwan;(2) Institute of Forensic Medicine, Ministry of Justice, Taipei, Taiwan;(3) Department of Pathology, Kaohsiung Medical University Hospital and College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;(4) Department of Rheumatology, Chang Gung Memorial Hospital-Kaohsiung Medical Center and College of Medicine, Chang Gung University, Kaohsiung, Taiwan |
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Abstract: | Ankylosing spondylitis (AS) is an autoimmune spondyloarthropathy involving principally the sacroiliac joint and axial skeleton.
Spinal cord involvement is an infrequent and late complication. It mostly results from compressive myelopathy due to skeletal
osteopathy and usually presents with radiculomyelopathic sensory and motor deficits. To report three patients who suffered
a progressive paraparesis/tetraparesis compatible with motor myelopathy without typical skeletal symptom. Myelopathy of unknown
origin was initially interpreted in these patients. Radiography did not show typical change at sacroiliac joint or vertebrate.
Spinal magnetic resonance image revealed cord atrophy at cervical and thoracic segment. A positivity of B27 antigen was found
afterward. Their spondyloarthropathic symptoms developed within six months later with radiographic sacroiliitis. Seropositive
AS with noncompressive myelopathy was finally established. Patients showed a reverse of motor impairment when their pain was
well undercontrolled. Motor myelopathy may be neglected or underestimated in AS, in especially when typical skeletal symptom
is absent or minimal. It may progress surreptitiously to harm spinal function or superimpose to crippling disability in compressive
spinal cord injury. Therefore, a careful evaluation and monitor of spinal cord function is important for AS patient despite
spinal deformity is not observed. |
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