ĐẶC ĐIỂM LÂM SÀNG VÀ CẬN LÂM SÀNG CỦA BỆNH NHÂN VIÊM TỦY TRONG XƠ CỨNG RẢI RÁC VÀ TRONG PHỔ VIÊM TỦY THỊ THẦN KINH

Abstract

Introduction: Myelitis is often associated with autoimmune demyelinating disorders of the central nervous system such as multiple sclerosis (MS) and neuromyelitis optica spectrum (NMOSD). The clinical manifestations of MS and NMOSD are diverse, overlapping and difficult to distinguish from each other. Misdiagnosis and unappropriate treatment can increase disability. Therefore, early differential diagnosis of these two diseases is important to improve outcomes and prognosis. However, data on the differences in myelitis characteristics between MS and NMOSD in Vietnam are limited.

Objective: Comparing myelitis characteristics including clinical, cerebrospinal fluid (CSF) and MRI features between MS and NMOSD.

Subjects and methods: Retrospective cross-sectional descriptive study of 67 cases of myelitis (19 MS and 48 NMOSD) at the University Medical Center of Ho Chi Minh City from January 2021 to December 2023.

Results: The NMOSD group had a higher proportion of women than MS (95.8% vs. 52.6%, respectively). The age at onset of NMOSD patients was often in middle age (median 39 years old), while MS patients often had the onset at young age (median 23 years old). In terms of clinical manifestations, the NMOSD group had lower total limb muscle strength (median 16 vs. 20), a higher rate of trunk sensory level (64.4% vs. 21.1%), and a higher rate of requirement for urinary catheterization than the MS group (31.9% vs. 0%). Regarding CSF features, the NMOSD group had a higher white blood cell count (median 11 vs. 4.5 cells/mm³), higher protein concentration (median 43.5 vs. 32.5 mg/dL), and a lower rate of positive CSF OCB than the MS group (2.7% vs. 36.8%). MRI lesions in the NMOSD group were more common in the thoracic and central regions, whereas lesions in the MS group were mainly located in the cervical and peripheral regions. NMOSD had fewer lesions (median 1 vs. 2 lesions) but these leisions were significantly longer than those of MS (median 6 vs. 2 vertebrae). The “bright spotty” sign was found in 58.3% of NMOSD cases, while it was absent in MS. During the first attack, significant differences between the two groups included: the NMOSD group had longer spinal cord lesions (median 6.5 vs. 2 vertebrae) and a higher rate of enhancement than the MS group (90% vs. 28.6%), the “bright spotty” sign was only seen in the NMOSD group.

Conclusion: The severity of clinical symptoms and spinal cord lesions on imaging in NMOSD is often more severe than in MS. The combination of specific clinical, CSF and spinal cord MRI characteristics are effective in distinguishing myelitis due to NMOSD and MS in order to have early appropriate treatment strategies.