Role of MRI in Non-Traumatic Paraparesis and Tetraparesis

Research Article

Austin J Radiol. 2015; 2(7): 1040.

Role of MRI in Non-Traumatic Paraparesis and Tetraparesis

Birendra Raj Joshi*

Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, Nepal

*Corresponding author: Birendra Raj Joshi, Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, Kathmandu, Nepal

Received: September 09, 2015; Accepted: November 24, 2015; Published: December 05, 2015

Abstract

Background: This study was performed to assess the frequency of various causes of non-traumatic paraparesis and tetraparesis based on the findings of Magnetic Resonance Imaging [MRI].

Patients and Methods: A total of fifteen patients who presented with nontraumatic paraparesis and tetraparesis were studied. MRI of spine of all patients and MRI of brain of selected patients were carried out. Based on MRI findings alone causes of non-traumatic paraparesis and tetraparesis were categorized.

Results: Twelve cases were of paraparesis and three cases were of tetraparesis. Male to female ratio was 2:1. Mean age was 32.7. Infective spondylitis is still one of the common causes of paraparesis in developing countries accounting for almost 33% .Spondylotic myelopathy is the single most common cause of non-traumatic tetraparesis.

Conclusion: MRI is useful in differentiating between various causes of cord compression like neoplastic, spondylotic and infective lesions. Clinical and imaging evaluation of patients vary according to different regions.

Keywords: Cord compression; MRI; Myelopathy; Paraparesis; Tetraparesis

Introduction

Paraparesis and tetraparesis refers to weakness of both limbs and all four limbs respectively. The causes of non-traumatic paraparesis and tetraparesis are cord compression and non-compressive myelopathies. Acute cord compression should be diagnosed and treated early to prevent permanent neurological deficit. Cord compresssion may be due to primary or metastatic neoplastic diseases, degenerative disease, infective spondylitis, epidural abscess or hemorrhage and syringomyelia. MRI outlines the level and extent of cord compression. It can also differentiate various causes and site of origin. The causes of non-compressive myelopathies are infections [1] of cord, demyelinating and neuronal degenerative diseases, postinfectious and post vaccination myelopathies [2], post radiation myelopathies, cord ischemia and nutritional deficiencies and toxins. This study was carried out to assess the frequencies of compressive and non-compressive causes of non-traumatic paraparesis and tetraparesis using MRI alone in adult patients.

Patients and Methods

This descriptive, non-interventional study was carried out from July to December 2013. A total of fifteen patients who were referred for MRI due to non-traumatic paraparesis and tetraparesis were studied. MRI of cervical, dorsal and lumbar spine was carried out in the study using 0.2 Tesla MRI machine. A combination of sagittal and axial T1 and T2 weighted images were obtained in all patients. Coronal T1WI and T2WI were taken in some patients. Slice thickness was varied from 3-6 mm. Contrast enhanced scanning was done in selected cases. Post contrast sagittal and axial T1WI were taken. Gadolinium 0.1mmol\kg of bodyweight was used as intravenous contrast agent. Special sequences like fat saturation T1WI were also taken in some cases.

Based on MRI findings causes of paraparesis and tetraparesis were divided into two main categories. All those patients in whom there was evidence of compression of thecal sac and spinal cord were grouped together as cord compression. All those patients in whom there was no evidence of cord compression and no intracranial cause were identified for their symptoms were grouped together as noncompressive myelopathies. Age, gender, presenting complaint and MR disease category were recorded and these variables were analyzed.

Results

There were 15 cases who were included in the study. Out of which 12 were of paraparesis and 3 were of tetraparesis. Male to female ratio was 2:1 (Table 1 & 2).