Metabolic and Toxic Myelopathies

Michaël C. C. Slama; Aaron L. Berkowitz

doi:10.1055/s-0041-1725150

Seminars in Neurology, Inhaltsverzeichnis

Semin Neurol 2021; 41(03): 309-326
DOI: 10.1055/s-0041-1725150

Review Article

Metabolic and Toxic Myelopathies

Michaël C. C. Slama

¹Department of Neurology, St. Elizabeth's Medical Center, Boston, Massachusetts

,

Aaron L. Berkowitz

²Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

› Institutsangaben

Abstract

Metabolic and toxic causes of myelopathy form a heterogeneous group of disorders. In this review, we discuss the causes of metabolic and toxic myelopathies with respect to clinical presentation, pathophysiology, diagnostic testing, treatment, and prognosis. This review is organized by temporal course (hyperacute, acute, subacute, and chronic) and etiology (e.g., nutritional deficiency, toxic exposure). Broadly, the myelopathies associated with dietary toxins (neurolathyrism, konzo) and decompression sickness present suddenly (hyperacute). The myelopathies associated with heroin use and electrical injury present over hours to days (acutely). Most nutritional deficiencies (cobalamin, folate, copper) and toxic substances (nitrous oxide, zinc, organophosphates, clioquinol) cause a myelopathy of subacute onset. Vitamin E deficiency and hepatic myelopathy cause a chronic myelopathy. Radiation- and intrathecal chemotherapy-induced myelopathy can cause a transient and/or a progressive syndrome. For many metabolic and toxic causes of myelopathy, clinical deficits may stabilize or improve with rapid identification and treatment. Familiarity with these disorders is therefore essential.

Keywords

metabolic - toxic - myelopathy - myeloneuropathy

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References
1 Russell JSR, Batten FE, Collier J. Subacute combined degeneration of the spinal cord. Brain 1900; 23 (01) 39-110
2 Reynolds EH. The neurology of folic acid deficiency. In: Biller J, Ferro JM. eds. Handbook of Clinical Neurology. Vol 120. (Neurologic Aspects of Systemic Disease Part II; ). Elsevier; 2014: 927-943
3 Goodman BP. Metabolic and toxic causes of myelopathy. Continuum (Minneap Minn) 2015; 21 (1 Spinal Cord Disorders): 84-99
4 Schwendimann RN. Metabolic and toxic myelopathies. Continuum (Minneap Minn) 2018; 24 (2, Spinal Cord Disorders): 427-440
5 Kashala-Abotnes E, Okitundu D, Mumba D, Boivin MJ, Tylleskär T, Tshala-Katumbay D. Konzo: a distinct neurological disease associated with food (cassava) cyanogenic poisoning. Brain Res Bull 2019; 145: 87-91
6 Tshala-Katumbay D, Mumba N, Okitundu L. et al. Cassava food toxins, konzo disease, and neurodegeneration in sub-Sahara Africans. Neurology 2013; 80 (10) 949-951
7 Nzwalo H, Cliff J. Konzo: from poverty, cassava, and cyanogen intake to toxico-nutritional neurological disease. PLoS Negl Trop Dis 2011; 5 (06) e1051
8 Banea JP, Nahimana G, Mandombi C, Bradbury JH, Denton IC, Kuwa N. Control of konzo in DRC using the wetting method on cassava flour. Food Chem Toxicol 2012; 50 (05) 1517-1523
9 Kambale KJ, Ali ER, Sadiki NH. et al. Lower sulfurtransferase detoxification rates of cyanide in konzo—a tropical spastic paralysis linked to cassava cyanogenic poisoning. Neurotoxicology 2017; 59: 256-262
10 Howlett WP, Brubaker GR, Mlingi N, Rosling H. Konzo, an epidemic upper motor neuron disease studied in Tanzania. Brain 1990; 113 (Pt 1): 223-235
11 Osuntokun BO. An ataxic neuropathy in Nigeria. A clinical, biochemical and electrophysiological study. Brain 1968; 91 (02) 215-248
12 Tylleskär T, Howlett WP, Rwiza HT. et al. Konzo: a distinct disease entity with selective upper motor neuron damage. J Neurol Neurosurg Psychiatry 1993; 56 (06) 638-643
13 Hedera P. Hereditary and metabolic myelopathies. Handb Clin Neurol 2016; 136: 769-785
14 Woldeamanuel YW, Hassan A, Zenebe G. Neurolathyrism: two Ethiopian case reports and review of the literature. J Neurol 2012; 259 (07) 1263-1268
15 Ludolph AC, Hugon J, Dwivedi MP, Schaumburg HH, Spencer PS. Studies on the aetiology and pathogenesis of motor neuron diseases. 1. Lathyrism: clinical findings in established cases. Brain 1987; 110 (Pt 1): 149-165
16 Kumar N. Metabolic and toxic myelopathies. Semin Neurol 2012; 32 (02) 123-136
17 Striefler M, Cohn DF, Hirano A, Schujman E. The central nervous system in a case of neurolathyrism. Neurology 1977; 27 (12) 1176-1178
18 Ramalho J, Nunes RH, da Rocha AJ, Castillo M. Toxic and metabolic myelopathies. Semin Ultrasound CT MR 2016; 37 (05) 448-465
19 Kamtchum Tatuene J, Pignel R, Pollak P, Lovblad KO, Kleinschmidt A, Vargas MI. Neuroimaging of diving-related decompression illness: current knowledge and perspectives. AJNR Am J Neuroradiol 2014; 35 (11) 2039-2044
20 Blatteau J-E, Gempp E, Simon O. et al. Prognostic factors of spinal cord decompression sickness in recreational diving: retrospective and multicentric analysis of 279 cases. Neurocrit Care 2011; 15 (01) 120-127
21 Gempp E, Blatteau J-E, Stephant E, Pontier J-M, Constantin P, Pény C. MRI findings and clinical outcome in 45 divers with spinal cord decompression sickness. Aviat Space Environ Med 2008; 79 (12) 1112-1116
22 Hennedige T, Chow W, Ng YY, Chung-Tsing GC, Lim TCC, Kei PL. MRI in spinal cord decompression sickness. J Med Imaging Radiat Oncol 2012; 56 (03) 282-288
23 Gempp E, Blatteau J-E. Risk factors and treatment outcome in scuba divers with spinal cord decompression sickness. J Crit Care 2010; 25 (02) 236-242
24 Richter RW, Rosenberg RN. Transverse myelitis associated with heroin addiction. JAMA 1968; 206 (06) 1255-1257
25 Ell JJ, Uttley D, Silver JR. Acute myelopathy in association with heroin addiction. J Neurol Neurosurg Psychiatry 1981; 44 (05) 448-450
26 Goodhart LC, Loizou LA, Anderson M. Heroin myelopathy. J Neurol Neurosurg Psychiatry 1982; 45 (06) 562-563
27 Grassa C, Montanari E, Scaglioni A, Passeri S, Saginario M. Acute heroin myelopathy–case report. Ital J Neurol Sci 1984; 5 (01) 63-66
28 McCreary M, Emerman C, Hanna J, Simon J. Acute myelopathy following intranasal insufflation of heroin: a case report. Neurology 2000; 55 (02) 316-317
29 Ivanovski T, Espino Ibañez AM, Barcelo Martin B, Gomila Muñiz I. Acute extensive myelopathy after single heroin and cocaine exposure in a patient with toxicological evidence of long-term drug abstinence. BMJ Case Rep 2019; 12 (03) e228335
30 Riva N, Morana P, Cerri F. et al. Acute myelopathy selectively involving lumbar anterior horns following intranasal insufflation of ecstasy and heroin. J Neurol Neurosurg Psychiatry 2007; 78 (08) 908-909
31 Mahoney KW, Romba M, Gailloud P, Izbudak I, Saylor D. Acute progressive paraplegia in heroin-associated myelopathy. J Clin Neurosci 2018; 51: 69-71
32 Dujmovic I, Nikolic I, Martinovic V, Mesaros S, Drulovic J. Heroin-induced acute longitudinally extensive transverse myelopathy. Neurol Sci 2018; 39 (04) 791-792
33 Nyffeler T, Stabba A, Sturzenegger M. Progressive myelopathy with selective involvement of the lateral and posterior columns after inhalation of heroin vapour. J Neurol 2003; 250 (04) 496-498
34 Sveinsson O, Herrman L, Hietala MA. Heroin-induced acute myelopathy with extreme high levels of CSF glial fibrillar acidic protein indicating a toxic effect on astrocytes. BMJ Case Rep 2017; 2017: bcr-2017-219903
35 Cherington M. Neurologic manifestations of lightning strikes. Neurology 2003; 60 (02) 182-185
36 Cherington M. Spectrum of neurologic complications of lightning injuries. NeuroRehabilitation 2005; 20 (01) 3-8
37 Sharma M, Smith A. Paraplegia as a result of lightning injury. BMJ 1978; 2 (6150): 1464-1465
38 Varghese G, Mani MM, Redford JB. Spinal cord injuries following electrical accidents. Paraplegia 1986; 24 (03) 159-166
39 Breugem CC, Van Hertum W, Groenevelt F. High voltage electrical injury leading to a delayed onset tetraplegia, with recovery. Ann N Y Acad Sci 1999; 888: 131-136
40 Ko SH, Chun W, Kim HC. Delayed spinal cord injury following electrical burns: a 7-year experience. Burns 2004; 30 (07) 691-695
41 Freeman CB, Goyal M, Bourque PR. MR imaging findings in delayed reversible myelopathy from lightning strike. AJNR Am J Neuroradiol 2004; 25 (05) 851-853
42 Davidson GS, Deck JH. Delayed myelopathy following lightning strike: a demyelinating process. Acta Neuropathol 1988; 77 (01) 104-108
43 ten Duis HJ, Klasen HJ, Reenalda PE. Keraunoparalysis, a ‘specific’ lightning injury. Burns 1985; 12 (01) 54-57
44 Kalita J, Jose M, Misra UK. Myelopathy and amnesia following accidental electrical injury. Spinal Cord 2002; 40 (05) 253-255
45 Leichtenstern OML. Über progressive perniciöse Anämie bei Tabeskranken. Dtsch Med Wochenschr 1884; 10: 849-850
46 Li J, Ren M, Dong A. et al. A retrospective study of 23 cases with subacute combined degeneration. Int J Neurosci 2016; 126 (10) 872-877
47 Cao J, Su Z-Y, Xu S-B, Liu C-C. Subacute combined degeneration: a retrospective study of 68 cases with short-term follow-up. Eur Neurol 2018; 79 (5-6): 247-255
48 Hemmer B, Glocker FX, Schumacher M, Deuschl G, Lücking CH. Subacute combined degeneration: clinical, electrophysiological, and magnetic resonance imaging findings. J Neurol Neurosurg Psychiatry 1998; 65 (06) 822-827
49 Lindenbaum J, Healton EB, Savage DG. et al. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988; 318 (26) 1720-1728
50 Jain KK, Malhotra HS, Garg RK, Gupta PK, Roy B, Gupta RK. Prevalence of MR imaging abnormalities in vitamin B12 deficiency patients presenting with clinical features of subacute combined degeneration of the spinal cord. J Neurol Sci 2014; 342 (1-2): 162-166
51 Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med 2013; 368 (02) 149-160
52 Goodman JC. Neurological complications of bariatric surgery. Curr Neurol Neurosci Rep 2015; 15 (12) 79
53 Remacha AF, Sardà MP, Canals C. et al. Role of serum holotranscobalamin (holoTC) in the diagnosis of patients with low serum cobalamin. Comparison with methylmalonic acid and homocysteine. Ann Hematol 2014; 93 (04) 565-569
54 Kumar A, Singh AK. Teaching NeuroImage: inverted V sign in subacute combined degeneration of spinal cord. Neurology 2009; 72 (01) e4
55 Sen A, Chandrasekhar K. Spinal MR imaging in Vitamin B12 deficiency: case series; differential diagnosis of symmetrical posterior spinal cord lesions. Ann Indian Acad Neurol 2013; 16 (02) 255-258
56 Sun HY, Lee JW, Park KS, Wi JY, Kang HS. Spine MR imaging features of subacute combined degeneration patients. Eur Spine J 2014; 23 (05) 1052-1058
57 Wang H, Li L, Qin LL, Song Y, Vidal-Alaball J, Liu TH. Oral vitamin B₁₂ versus intramuscular vitamin B₁₂ for vitamin B₁₂ deficiency. Cochrane Database Syst Rev 2018; 3: CD004655
58 Vasconcelos OM, Poehm EH, McCarter RJ, Campbell WW, Quezado ZMN. Potential outcome factors in subacute combined degeneration: review of observational studies. J Gen Intern Med 2006; 21 (10) 1063-1068
59 Kumar N. Neurologic presentations of nutritional deficiencies. Neurol Clin 2010; 28 (01) 107-170
60 Okada A, Koike H, Nakamura T, Watanabe H, Sobue G. Slowly progressive folate-deficiency myelopathy: report of a case. J Neurol Sci 2014; 336 (1-2): 273-275
61 Botez MI, Fontaine F, Botez T, Bachevalier J. Folate-responsive neurological and mental disorders: report of 16 cases. Neuropsychological correlates of computerized transaxial tomography and radionuclide cisternography in folic acid deficiencies. Eur Neurol 1977; 16 (1-6): 230-246
62 Pincus JH. Folic acid deficiency: a cause of subacute combined system degeneration. In: Folic Acid in Neurology, Psychiatry, and Internal Medicine. New York: Raven Press; 1979: 427-433
63 Nakamura T, Nishi M, Rikitake M. et al. A case of subacute combined degeneration of the spinal cord due to folic acid and copper deficiency. Brain Dev 2019; 41 (01) 111-115
64 Pincus JH, Reynolds EH, Glaser GH. Subacute combined system degeneration with folate deficiency. JAMA 1972; 221 (05) 496-497
65 Kumar N. Copper deficiency myelopathy (human swayback). Mayo Clin Proc 2006; 81 (10) 1371-1384
66 Jaiser SR, Winston GP. Copper deficiency myelopathy. J Neurol 2010; 257 (06) 869-881
67 Kumar P, Hamza N, Madhok B. et al. Copper deficiency after gastric bypass for morbid obesity: a systematic review. Obes Surg 2016; 26 (06) 1335-1342
68 Kumar N, Butz JA, Burritt MF. Clinical significance of the laboratory determination of low serum copper in adults. Clin Chem Lab Med 2007; 45 (10) 1402-1410
69 Afrin LB. Fatal copper deficiency from excessive use of zinc-based denture adhesive. Am J Med Sci 2010; 340 (02) 164-168
70 Schleper B, Stuerenburg HJ. Copper deficiency-associated myelopathy in a 46-year-old woman. J Neurol 2001; 248 (08) 705-706
71 Lanska DJ, Remler B. Myelopathy among zinc-smelter workers in Upper Silesia during the late 19th century. Neurology 2014; 82 (13) 1175-1179
72 Hendriks WH, Allan FJ, Tarttelin MF, Collett MG, Jones BR. Suspected zinc-induced copper deficiency in growing kittens exposed to galvanised iron. N Z Vet J 2001; 49 (02) 68-72
73 Kumar N, Ahlskog JE, Klein CJ, Port JD. Imaging features of copper deficiency myelopathy: a study of 25 cases. Neuroradiology 2006; 48 (02) 78-83
74 Thompson AG, Leite MI, Lunn MP, Bennett DLH. Whippits, nitrous oxide and the dangers of legal highs. Pract Neurol 2015; 15 (03) 207-209
75 Garakani A, Jaffe RJ, Savla D. et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict 2016; 25 (05) 358-369
76 Keddie S, Adams A, Kelso ARC. et al. No laughing matter: subacute degeneration of the spinal cord due to nitrous oxide inhalation. J Neurol 2018; 265 (05) 1089-1095
77 Patel KK, Mejia Munne JC, Gunness VRN. et al. Subacute combined degeneration of the spinal cord following nitrous oxide anesthesia: a systematic review of cases. Clin Neurol Neurosurg 2018; 173: 163-168
78 Ng J, Frith R. Nanging. Lancet 2002; 360 (9330): 384
79 Renard D, Dutray A, Remy A, Castelnovo G, Labauge P. Subacute combined degeneration of the spinal cord caused by nitrous oxide anaesthesia. Neurol Sci 2009; 30 (01) 75-76
80 Kinsella LJ, Green R. ‘Anesthesia paresthetica’: nitrous oxide-induced cobalamin deficiency. Neurology 1995; 45 (08) 1608-1610
81 Marié RM, Le Biez E, Busson P. et al. Nitrous oxide anesthesia-associated myelopathy. Arch Neurol 2000; 57 (03) 380-382
82 Morris N, Lynch K, Greenberg SA. Severe motor neuropathy or neuronopathy due to nitrous oxide toxicity after correction of vitamin B12 deficiency. Muscle Nerve 2015; 51 (04) 614-616
83 Ernst LD, Brock K, Barraza LH, Davis A, Nirenberg MJ. Longitudinally extensive nitrous oxide myelopathy with novel radiographic features. JAMA Neurol 2015; 72 (11) 1370-1371
84 Yuan JL, Wang SK, Jiang T, Hu WL. Nitrous oxide induced subacute combined degeneration with longitudinally extensive myelopathy with inverted V-sign on spinal MRI: a case report and literature review. BMC Neurol 2017; 17 (01) 222
85 Massey TH, Pickersgill TTJ. , J Peall K. Nitrous oxide misuse and vitamin B12 deficiency. BMJ Case Rep 2016; 2016: bcr2016215728
86 Williamson J, Huda S, Damodaran D. Nitrous oxide myelopathy with functional vitamin B ₁₂ deficiency. BMJ Case Rep 2019; 12 (02) e227439
87 Li H-T, Chu C-C, Chang K-H. et al. Clinical and electrodiagnostic characteristics of nitrous oxide-induced neuropathy in Taiwan. Clin Neurophysiol 2016; 127 (10) 3288-3293
88 Stacy CB, Di Rocco A, Gould RJ. Methionine in the treatment of nitrous-oxide-induced neuropathy and myeloneuropathy. J Neurol 1992; 239 (07) 401-403
89 Zittel S, Ufer F, Gerloff C, Münchau A, Rosenkranz M. Severe myelopathy after denture cream use–is copper deficiency or excess zinc the cause?. Clin Neurol Neurosurg 2014; 121: 17-18
90 Senanayake N, Karalliedde L. Neurotoxic effects of organophosphorus insecticides. An intermediate syndrome. N Engl J Med 1987; 316 (13) 761-763
91 Morgan JP, Penovich P. Jamaica ginger paralysis. Forty-seven-year follow-up. Arch Neurol 1978; 35 (08) 530-532
92 Chuang C-C, Lin T-S, Tsai M-C. Delayed neuropathy and myelopathy after organophosphate intoxication. N Engl J Med 2002; 347 (14) 1119-1121
93 Azazh A. Severe organophosphate poisoning with delayed cholinergic crisis, intermediate syndrome and organophosphate induced delayed polyneuropathy on succession. Ethiop J Health Sci 2011; 21 (03) 203-208
94 Ostwal P, Dabadghao VS, Sharma SK, Dhakane AB. Chlorpyrifos toxicity causing delayed myeloneuropathy. Ann Indian Acad Neurol 2013; 16 (04) 736
95 Beavers CT, Parker JJ, Flinchum DA, Weakley-Jones BA, Jortani SA. Pesticide-induced quadriplegia in a 55-year-old woman. Am J Forensic Med Pathol 2014; 35 (04) 239-241
96 Lotti M, Becker CE, Aminoff MJ. Organophosphate polyneuropathy: pathogenesis and prevention. Neurology 1984; 34 (05) 658-662
97 Mao X, Schimmer AD. The toxicology of clioquinol. Toxicol Lett 2008; 182 (1-3): 1-6
98 Schaumburg H, Herskovitz S. Copper deficiency myeloneuropathy: a clue to clioquinol-induced subacute myelo-optic neuropathy?. Neurology 2008; 71 (09) 622-623
99 Konagaya M. [SMON: toxicity of clioquinol and the status quo]. Brain Nerve 2015; 67 (01) 49-62
100 Kimura E, Hirano T, Yamashita S. et al. Cervical MRI of subacute myelo-optico-neuropathy. Spinal Cord 2011; 49 (02) 182-185
101 Sokol RJ. Vitamin E deficiency and neurologic disease. Annu Rev Nutr 1988; 8: 351-373
102 Vorgerd M, Tegenthoff M, Kühne D, Malin JP. Spinal MRI in progressive myeloneuropathy associated with vitamin E deficiency. Neuroradiology 1996; 38 (Suppl. 01) S111-S113
103 Nelson JS. Neuropathological studies of chronic vitamin E deficiency in mammals including humans. Ciba Found Symp 1983; 101: 92-105
104 Sokol RJ, Heubi JE, Iannaccone ST, Bove KE, Balistreri WF. Vitamin E deficiency with normal serum vitamin E concentrations in children with chronic cholestasis. N Engl J Med 1984; 310 (19) 1209-1212
105 Nardone R, Höller Y, Storti M. et al. Spinal cord involvement in patients with cirrhosis. World J Gastroenterol 2014; 20 (10) 2578-2585
106 Sureka B, Bansal K, Patidar Y, Rajesh S, Mukund A, Arora A. Neurologic manifestations of chronic liver disease and liver cirrhosis. Curr Probl Diagn Radiol 2015; 44 (05) 449-461
107 Sobukawa E, Sakimura K, Hoshino S, Hoshino M, Miyoshi K. Hepatic myelopathy: an unusual neurological complication of advanced hepatic disease. Intern Med 1994; 33 (11) 718-722
108 Gospe Jr SM, Caruso RD, Clegg MS. et al. Paraparesis, hypermanganesaemia, and polycythaemia: a novel presentation of cirrhosis. Arch Dis Child 2000; 83 (05) 439-442
109 Premkumar M, Bagchi A, Kapoor N. et al. Hepatic myelopathy in a patient with decompensated alcoholic cirrhosis and portal colopathy. Case Reports Hepatol 2012; 2012: 735906
110 Zieve L, Mendelson DF, Goepfert M. Shunt encephalomyelopathy. II. Occurrence of permanent myelopathy. Ann Intern Med 1960; 53: 53-63
111 Conn HO, Rössle M, Levy L, Glocker FX. Portosystemic myelopathy: spastic paraparesis after portosystemic shunting. Scand J Gastroenterol 2006; 41 (05) 619-625
112 di Biase L, Picillo M, Freitas ME, Bui E, Fasano A. Hepatitis C virus-related hepatic myelopathy after treatment with sofosbuvir and ribavirin: a case report. Ann Intern Med 2017; 166 (05) 379-380
113 Philips CA, Kumar L, Augustine P. Partial splenic artery embolization for severe hepatic myelopathy in cirrhosis. Hepatology 2018; 67 (03) 1169-1171
114 Weissenborn K, Tietge UJF, Bokemeyer M. et al. Liver transplantation improves hepatic myelopathy: evidence by three cases. Gastroenterology 2003; 124 (02) 346-351
115 Qu B, Liu C, Guo L. et al. The role of liver transplantation in the treatment of hepatic myelopathy: case report with review of the literature. Transplant Proc 2009; 41 (05) 1987-1989
116 Nardone R, Buratti T, Oliviero A, Lochmann A, Tezzon F. Corticospinal involvement in patients with a portosystemic shunt due to liver cirrhosis: a MEP study. J Neurol 2006; 253 (01) 81-85
117 Jellinger K, Sturm KW. Delayed radiation myelopathy in man. Report of twelve necropsy cases. J Neurol Sci 1971; 14 (04) 389-408
118 Fein DA, Marcus Jr RB, Parsons JT, Mendenhall WM, Million RR. Lhermitte's sign: incidence and treatment variables influencing risk after irradiation of the cervical spinal cord. Int J Radiat Oncol Biol Phys 1993; 27 (05) 1029-1033
119 Leung W-M, Tsang N-M, Chang F-T, Lo C-J. Lhermitte's sign among nasopharyngeal cancer patients after radiotherapy. Head Neck 2005; 27 (03) 187-194
120 Wong CS, Van Dyk J, Milosevic M, Laperriere NJ. Radiation myelopathy following single courses of radiotherapy and retreatment. Int J Radiat Oncol Biol Phys 1994; 30 (03) 575-581
121 Komachi H, Tsuchiya K, Ikeda M, Koike R, Matsunaga T, Ikeda K. Radiation myelopathy: a clinicopathological study with special reference to correlation between MRI findings and neuropathology. J Neurol Sci 1995; 132 (02) 228-232
122 Koehler PJ, Verbiest H, Jager J, Vecht CJ. Delayed radiation myelopathy: serial MR-imaging and pathology. Clin Neurol Neurosurg 1996; 98 (02) 197-201
123 Keřkovský M, Zitterbartová J, Pour L, Šprláková-Puková A, Mechl M. Diffusion tensor imaging in radiation-induced myelopathy. J Neuroimaging 2015; 25 (05) 836-840
124 Schultheiss TE, Stephens LC, Maor MH. Analysis of the histopathology of radiation myelopathy. Int J Radiat Oncol Biol Phys 1988; 14 (01) 27-32
125 Okada S, Okeda R. Pathology of radiation myelopathy. Neuropathology 2001; 21 (04) 247-265
126 Soussain C, Ricard D, Fike JR, Mazeron J-J, Psimaras D, Delattre J-Y. CNS complications of radiotherapy and chemotherapy. Lancet 2009; 374 (9701): 1639-1651
127 Lengyel Z, Rékó G, Majtényi K. et al. Autopsy verifies demyelination and lack of vascular damage in partially reversible radiation myelopathy. Spinal Cord 2003; 41 (10) 577-585
128 Levin VA, Bidaut L, Hou P. et al. Randomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system. Int J Radiat Oncol Biol Phys 2011; 79 (05) 1487-1495
129 Chamberlain MC, Eaton KD, Fink J. Radiation-induced myelopathy: treatment with bevacizumab. Arch Neurol 2011; 68 (12) 1608-1609
130 Psimaras D, Tafani C, Ducray F. et al. Bevacizumab in late-onset radiation-induced myelopathy. Neurology 2016; 86 (05) 454-457
131 Gagliano RG, Costanzi JJ. Paraplegia following intrathecal methotrexate: report of a case and review of the literature. Cancer 1976; 37 (04) 1663-1668
132 Cachia D, Kamiya-Matsuoka C, Pinnix CC. et al. Myelopathy following intrathecal chemotherapy in adults: a single institution experience. J Neurooncol 2015; 122 (02) 391-398
133 Dunton SF, Nitschke R, Spruce WE, Bodensteiner J, Krous HF. Progressive ascending paralysis following administration of intrathecal and intravenous cytosine arabinoside. A Pediatric Oncology Group study. Cancer 1986; 57 (06) 1083-1088
134 Murata KY, Maeba A, Yamanegi M, Nakanishi I, Ito H. Methotrexate myelopathy after intrathecal chemotherapy: a case report. J Med Case Reports 2015; 9: 135
135 Yi Y, Kang HJ, Shin HY, Kim K. Progressive myelopathy mimicking subacute combined degeneration after intrathecal chemotherapy. J Child Neurol 2015; 30 (02) 246-249
136 Shintaku M, Toyooka N, Koyama T, Teraoka S, Tsudo M. Methotrexate myelopathy with extensive transverse necrosis: report of an autopsy case. Neuropathology 2014; 34 (06) 547-553
137 Pinnix CC, Chi L, Jabbour EJ. et al. Dorsal column myelopathy after intrathecal chemotherapy for leukemia. Am J Hematol 2017; 92 (02) 155-160
138 Joseph PJ, Reyes MR. Dorsal column myelopathy following intrathecal chemotherapy for acute lymphoblastic leukemia. J Spinal Cord Med 2014; 37 (01) 107-113
139 Ackermann R, Semmler A, Maurer GD. et al. Methotrexate-induced myelopathy responsive to substitution of multiple folate metabolites. J Neurooncol 2010; 97 (03) 425-427