NEUROPATHOLOGY OF THE BRAIN-STEM AND SPINAL-CORD IN END-STAGE RHEUMATOID-ARTHRITIS - IMPLICATIONS FOR TREATMENT

被引:34
作者
HENDERSON, FC
GEDDES, JF
CROCKARD, HA
机构
[1] NATL HOSP NEUROL & NEUROSURG, DEPT SURG NEUROL, QUEEN SQ, LONDON WC1N 3BG, ENGLAND
[2] UNIV LONDON LONDON HOSP, COLL MED, DEPT MORBID ANAT, LONDON E1 1BB, ENGLAND
[3] USN, MED CTR, DEPT NEUROSURG, BETHESDA, MD 20814 USA
关键词
D O I
10.1136/ard.52.9.629
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective To study the detailed histopathological changes in the brainstem and spinal cord in nine patients with severe end stage rheumatoid arthritis, all with clinical myelopathy and craniocervical compression. Methods-At necropsy the sites of bony pathology were related exactly to cord segMents and histological changes, and correlated with clinical and radiological findings. Results-Cranial nerve and brainstem pathology was rare. In addition to the obvious craniocervical compression, there were widespread subaxial changes in the spinal cord. Pathology was localised primarily to the dorsal white matter and there was no evidence of vasculitis or ischaemic changes. Conclusions-Myelopathy in rheumatoid arthritis is probably caused by the effects of compression, stretch, and movement, not ischaemia. The additional subaxial compression may be an important component in the clinical picture, and may explain why craniocervical decompression alone may not alleviate neurological signs.
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页码:629 / 637
页数:9
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