원인불명의 척수병증(Myelopathy of Unknown Origin: MUO)에 관한 임상적 고찰

Abstract

A clinical study was carried outin 41 patients with MUO(Myelopathy of Unknown Origin), who were admitted to the Keimyung University Dongsan hospital from January 1985 to March 1989. The results were as follws: 1. Mean age at the time of admission was 44 years (from 22 to 69 years), and there were 32 men and 9 women(3.5:1). 2. the modes of onset were acute in 14.6%, subacute in 2.5% and chronic in 82.9%. The clinical symptoms & signs were paresthesia(87.8%), gait disturbance(70.7%), motor weakness(65.9%), hyperreflexia(82.9%) and Babinski sign(43.9%), and the most common type of sensory loss was the loss of all modalities(34.1%) which were pain, temperature, position and vibration, and the most common type of motor weakness was mild form (46.3%). 3. According to the neurologic examination, the sites of lesion were thoracic(43.9&). lumbar(41.5%) and cervical(14.6%) in order of requency and the most common type in cross sectional involvement was simultaneous involvement of many spinal tracts(46.3%) including the spinothalamic tract, corticospinal tract and posterior column. The bilateral symmetric cord lesion was common(78%). 4. In the cerebrospinal fluid analysis, there were increased IgG in 4 of 36(11.1%) patients, increased IgG/albumin ration in 10 of 27 (37.0%) patients and increased IgG indes in 10 of 18(55.6%) patients. 5. According to the electrophysiologic studies, abnormal findings which suggested the evidence of myelopathy were observed in 2 of 24 (13.8%) patients by median somatosensory evoked potntials and 2 of 5 (40%) patients by tibial somatosensory evoked potentials. 6. After the treatment of ACTH for 14 days in 28 of 41 (68.3%) patients, the sensory and motor disturbances were improved in 53.6%, stationary in 39.3% and aggravated in 7.1%. 7. After follow-up evaluation for average 44 months from onset, the clinical courses were stationary in 46.3%, improved in 36.6%. aggravated in 14.6% and recovered in 2.5%. In the fruture, the causes of MUO(Myelopathy of Unknown Origin) may be clarified by a long-term clinical follow-up, by the accurate electrophysiologic studies, laboratory findings and diagnostic imagings, above all by the neuronathologic findings from the necroptic studies.