Metabolic and Toxic Myelopathies

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

Publikationsverlauf

Artikel online veröffentlicht:
19. Mai 2021

• 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