Causes and outcome of non-traumatic spinal cord diseases at the neurology unit of Befelatanana hospital, Antananarivo, Madagascar

Abstract

Background Etiology confirmation of non-traumatic spinal cord diseases are still a problem in Africa and so their treatment and management of neurological disabilities. In Madagascar, only two cases of myelitis have been published until now. Objective To describe causes and outcome of spinal cord diseases to rise the etiology diagnosis challenge and improvement of our management. Methods A prospective descriptive study was conducted between November 2017 and March 2019. It included any patient with spinal cord disease semiology. Auxillary findings with biology and spinal MRI were prescribed. Outcome was evaluated by the Lipton and Taesdall scale. Results Twenty-two of 1149 patients were included. Fifteen performed spinal MRI. Seven infectious etiology: 03 schistosomiasis and 04 tuberculosis. Six non-infectious etiology: 02 myelitis, 01 vascular malformation, 02 metastatic spinal cord disease, 01 meningioma. No etiology found in 09 patients. Thirteen benefited corticosteroid bolus. Specific management for those with etiology. Functional rehabilitation for all. Disabilities outcome didn't worsen for the majority of cases that was managed at the disease starting. Only 02 patients developed a bedsore and phlebitis of the lower limbs. Conclusion In poor settings as Madagascar, diagnosis tools and drug options for spinal cord diseases are often nonavailable or nonaffordable. Results of this study rise the point of challenge with local facilities and financial features versus skills of Malagasy neurologist well trained worldwide. International collaboration with other specialities for training, care and research are useful and encouraged for nervous system disease management in poor settings.