ACUTE NECROTIC MYELOPATHY ASSOCIATED WITH ACUTE DISSEMINATED ENCEPHALOMYELITIS: CASE REPORT WITH POSTMORTEM STUDY
A fatal case is described of a 32-year-old male with acute necrotic myelopathy unusually associated with acute disseminated encephalomyelitis. The patient developed rapidly progressive quadriplegia, urinary retention and subsequent unconsciousness in the later stage, preceded by a few days of fever, headache, back pain, vertigo, tinnitus and blurred vision. He died on the thirteenth day of his illness, complicated by bronchopneumonia. Postmortem examination revealed transverse necrosis with small hemorrhages extensively in the cervical, thoracic and, of milder degree, lumbar cord. Axons as well as myelins were almost completely destroyed with proliferation of small amounts of lipid-laden macrophages and scanty perivascular infiltrates of lymphocytes in severely involved areas of the cord. In addition, inflammatory demyelinations were scattered perivascularly throughout the cerebral hemispheres, cerebellum, brain stem and optic nerves. This case is assumed to be an example of acute disseminated encephalomyelitis with special involvement of the spinal cord from the clinical course and pathological features. The pathogenesis of acute necrotic myelopathy is discussed together with brief review of similar cases hitherto described.