Multiple sclerosis, neuromyelitis optica, acute disseminated encephalomyelitis. 4. Heredofamilial/Degenerative diseases

Delayed myelopathy may follow after some years. Other features include low hair line, short neck and restricted neck movements (Field's triad). Dysplastic face, associated congenital anomalies and absence of cranial nerve palsies. Diagnosis - is made from radiographs of neck in flexion and extension. Treatment - Surgical fusion of atlanto-axial joint. 2. Basilar invagination - Displacement of dense of axis into foramen magnum Usually presents as picture of posterior fossa lesion. Clinical features - LoSwer cranial nerve palsies, cerebellar signs, spinothalamic variety of sensory loss over the arms, and signs of increased intracranial pressure. Radiography - Dense of axis is seen to extend above a line drawn from the posterior end of hard palate to posterior tip of foramen magnum. 3. Occipitalization or fusion of other cervical vertebrae - (Klippel-Feil anomaly) - Usually asymptomatic. Signs due to other associated anomalies. 4. Arnold Chiari malformation - The medulla and cerebellum are elongated and extend down through the foramen magnum Usually presents with cerebellar signs and syringomyleia or syringobulbia-like clinical picture. Spina bifida frequent. Non-compressive spinal cord syndromes (Non-compressive myelopathy - NCM) Myelopathy is a generic name for specific disorders of the spinal cord by a heterogenous group of conditions in which there is acute, subacute or chronic involvement of the sp.cord with or without involvement of nerve roots (Myeloradiculopathy) or peripheral nerves (Myeloneuropathy). Causes 1. Infections (a) Viral - Poliomyelitis, rabies, herpes zoster/varicella, mumps, viral hepatitis, EV 70, AIDS (b) Bacterial/spirochetal - Bacterial meningitis, tuberculosis, typhoid, syphilis. (c) Parasitic - Malaria (falciparum), schitosomiasis. 2. Immuno-Allergic (post and parainfectious) - Influenza and other viral infections, post-exanthematous (measles, varicella), post-vaccinal (rabies, poliomyelitis) 3 Demyelinating diseases - Multiple sclerosis, neuromyelitis optica, acute disseminated encephalomyelitis. 4. Heredofamilial/Degenerative diseases - MND, heredo-familial spastic paraplegia, spino-cerebellar ataxia, syringomyelia. 5. Toxic myelopathy - Neurolathyrism, intrathecal injections (chemotherapeutic agents, penicillin, spinal anaesthetics), contrast media, TOCP, arsenic, SMON. 6. Vascular disorders - Anterior spinal artery infarction, dissecting aneurysm of aorta, angiography, SLE, PAN, vascular malformations (angiomas, AV malformations). Physical agents - Irradiation myelopathy, electrical injury to sp.cord. 8. Metabolic/Nutritional -Vitamin B12 deficiency, pellagra, myelopathy of Chronic liver disease, adrenomyeloneuropathy. 9 Tropical spastic paraplegia - HTLV-1 associated myelopathy. 10. Intramedullary tumours - Astrocytoma, ependymoma, lipoma, haemangioma, metastasis. 11. Carcinomatous myelopathy (Non-metastatic manifestation). Acute syndromes: 1. Post-infectious transverse myelitis - following infection of upper respiratory tract or post-varicella, measles, mumps, syphilic or post mycoplasma. Raely SLE 2 Multiple sclerosis - develops hours or days, usually with a partial cord syndrome. Partial or complete remission over several weeks. 3. Anterior spinal artery infarcts - develop over minutes to hours. There is paraplegia with dissociated anaesthesia. As a rule, there is little recovery. 4. Trauma - Sudden onset of weakness or complete paralysis following injury to sp cord 5. Epidural abscess- Suppurative process elsewhere in the body, fever, backache and vertebral tenderness. II: Chronic syndromes 1. Multiple sclerosis - 10% of patients present with slowly progressive neurological