Diagnostic significance of cereborspinal-fluid examinations in myelopathy.

Abstract

The diagnostic significance of CSF signs in myelopathy has been investigated. The CSF signs were compared with the other clinical data in 103 patients: 58 with myelopathy of known cause and 45 with that of undetermined cause. All the patients had been thoroughly examined, e.g. in most cases gas myelography was performed. The CSF examinations included cell analyses, determination of the protein concentration, electrophoresis and, generally, mastix reaction. The same technique of paper electrophoresis was employed in the entire material. The results were classified in accordance with characteristic patterns, corrected for serum electrophoretic distributions (Kjellin 1969). Forty % of the cases of myelopathia NUD were demonstrated at the clinical follow-up examinations to be either proved or probable MS, in good agreement with the initial CSF signs. About 20 % had slightly pronounced CSF signs similar to those in MS, but which hitherto had not been supported by a clinical diagnosis. About five % were meningo-myelitis or atypical MS. Thus, more than 60 % of myelopathia NUD cases may be MS with apparently a special clinical pattern: a relatively high age of onset and frequently a protracted, slow progression of the symptoms, with spinal localization of long duration. Systemic diseases were the cause of myelopathy in from five to seven %. In about five % of the myelopathia NUD cases there were “degenerative”, electrophoretic, CSF patterns. In about one-fourth unspecific (“barrier-damage”) signs were present or nothing noteworthy was found. Pronounced CSF signs, as seen in MS, were present in 44 % of the patients with myelopathia NUD, but only in 3 % of those with myelopathy with determined cause; one patient with B12-myelopathy and the other with disc protrusion, possibly with concomitant MS. It should be pointed out that increased CSF-gamma-globulin concentrations should be given serious consideration in cases where disc protrusions are the supposed cause of myelopathy. If signs of obstructed spinal CSF flow are absent, the diagnosis MS has to be taken into consideration.