Stroke: New indicators distinguish between spontaneous spinal infarction and acute spinal cord inflammation

Spontaneous spinal infarction (SCI) is a disabling cause of acute spinal cord lesions and is often underestimated, possibly due to relatively rare clinical and magnetic resonance imaging (MRI) characteristics that often overlap with other more common causes of acute spinal lesions (especially acute spinal corditis) and lack of specific biomarkers.
can be included in possible clinical trials if patients can be identified, but uncertainty about diagnosis is an important limitation, so there is no proven effective treatment for SCI.
Although typical SCI manifests itself as ultra-acute severe spinal lesions (within 4-12 hours) and specific accompanying MRI characteristics (e.g. dispersion-weighted imaging limitations of spinal cord lesions), establishing a clear ultra-acute manifestation is not always direct About 25 percent of cases have a long-term, often step-by-step, performance within 12-24 hours, both during peri-surgery and spontaneous SCI, which makes the distinction with acute spinal corditis challenging.
an objective and widely available biomarker to distinguish between SCI and other causes will facilitate faster and more accurate identification of patients and avoid empirical attempts at unnecessary and potentially harmful treatments in situations of uncertainty.
neural silk light chain (NfL) is a major component of the neuron cell skeleton and has recently become an attractive biomarker for nerve axis damage in various neurological disorders.
studies have shown that NfL levels in the serum increase in the first few days of initial damage and remain elevated for about 3 months, reflecting the extent of nerve shaft damage.
serum NfL levels strongly depend on the nature of nerve damage (e.g., ishealth damage is likely to lead to the release of NfL in the serum rather than inflammation) and range (i.e., larger lesions release a larger amount of NfL).
this, Elia Sechi of Mayo Clinic in the United States and others studied whether the ratio of serum nerve wire light chain level to MRI T2 lesions area (neural wire light chain/area ratio-NAR) can distinguish the similar severity of SCI from acute myelitis.
they retrospectively identified patients at the Mayo Clinic (January 1, 2000-December 31, 2019), with (1) SCI, (2) AQP4 (aquaporin 4) - IgG or MOG (myelin less protrusion glioblastoid glycosin)-IgG-related myelitis, or (3) myelitis.
and measured the level of serum nerve wire light chain (pg/mL) in these patients.
and quantify the maximum area of spinal cord lesions (mm2) per patient.
results showed that 48 cases were included in SCI patients, 20 cases (clear, 11 cases; possible, 6 cases; possible, 3 cases), 28 cases of acute spinal corditis (AQP4-IgG-related, 17 cases; MOG-IgG-related, 5 cases; idlytic transverse myitis, 6 cases).
(range) of the scale score for expanded disability in the late stages of myelitis were 7.75 (2-8.5) and 5.5 (2-8), respectively.
compared to patients with AQP4-IgG-related myelitis, MOG-IgG-related myelitis, and idynial transverse myocarditis, SCI patients had significantly higher levels of serum nerve silk light chain levels of serum nerve silk light chain (P-0.01).
NAR has the highest accuracy in identifying SCI and acute myelitis, with a value of ≥0.35pg/(mL-mm2) producing 86% specificity and 95% sensitivity (AUC=0.93).
Days after adjusting age, sex, pre-sampling immunotherapy, and bone marrow disease symptoms occurred to sample, NAR was still independently associated with SCI (P-0.0007) The significance of the study was the discovery that the neural cord light chain/area ratio-NAR was a good clinical biomarker for distinguishing spontaneous spinal cord infarction from acute spinal cord inflammation.
origins: Sechi, E., Mariotto, S., McKeon, A., Krecke, K.N., Pittock, S.J., Ferrari, S., S.... & Zalewski, N. L. (2020). Serum Neurofilament to Magnetic Resonance Imaging Lesion Area Ratio Differentiates Spinal Cord Infarction From Acute Myelitis. _Stroke_, STROKEAHA-120. Freeman Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Mets Medicine" or "Source: MedSci Originals" are owned by Mets Medical and are not reproduced by any media, website or individual without authorization, and are authorized to be reproduced with the words "Source: Mets Medicine".
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