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What causes bulky spinal cord?
Question: hello doctor, my sister underwent LSCS on 12-feb-2014. after that baby had some respiratory problem and was under hospital care for 5 days. from 21-feb-2014 there was pain and swelling in bartholin gland. on 25-feb-2014 pus was extracted from the cyst. even then pain was not relieved. finally on 27-feb-2014 marsupilization surgery of bartholin was done. this reduced the pain. antibiotics and pain releivers were continued. again on 10-mar-2014 there was severe fever with pain in the back of neck. dolo 650 was used for fever. it did not subside. on 13-mar-2014, we took doctor appointment and went to hospital and when she get out of car was unable to walk and somehow managed to climb steps with my and my father's assistance. upon doctors advice lab tests for malaria and typhoid were done. falciparum malaria was weakly reactive and typhoid was positive. same day she got admitted to another hospital and the same tests were repeated and malaria was not present but typhoid was present. on 13-mar-2014 night when she wanted to urinate she took our support to go to washroom but she fell down suddenly and now she could'nt even stand on her legs. it started with left leg. treatement of antibiotics was continued for 5 days and tests and mri scans for spine, brain and even nerve conduction studies were done for leg problem. all were turned normal with exception of mri spine showing "relatively bulky spinal cord with evidence of patchy T2 hyperintensities" and "patchy ASI which is slightly hyper on T2 noted in the lower cord from D11-L1 level. the cord is relatively bulky". they suggested to visit another hospital for further evaluation. in the new hospital neuro chief suspected this a GB syndrome and later on took the reports that were done so far and also advised another round of similar tests and next day reports turned out to be normal. and they told this is "myelitis with paraplegia". for this they started methylprednisolone of high dose and 3rd day of the dose completed and 2 more days to go. dear specialist... please give us your valuable advise on my sister's problem and the chances of her walking back again. not sure why my sister got to this situation besides taking lot of care and cleanliness in her pregnancy. one more point is - she is 26 yr old now and got married in may-2011 and went for copper t-loop in oct-2011. loop was took out in apr-2013 for pregnancy and got conceived on may-2013. during pre-natal tests most of the times she has little urine infection. were there any such cases earlier which got recoverd and patient walked again. were there any such cases earlier where recovery was not good and patient did not walked again. please let us know your suggestions doctor. thank you, XXXXXXX
Brief Answer: Diagnosis and treatment so far are correct. Detailed Answer: Hi, Thank you for posting your query. I have noted the details of your sister's illness, and the treatment received so far. I agree with her doctors that she has myelitis- infection of the spinal cord, leading to paraplegia- weakness of legs. Initial treatment with methylprednisolone (high dose steroids) is correct, as it reduces the swelling in spinal cord and aids in recovery. At this stage, physiotherapy is the mainstay of therapy. Good exercises and rehabilitation is the key. Among medical treatment, if there is swelling of spinal cord still present, then, Plasmapheresis or immunoglobulin injections could also be tried. I hope it helps. Please get back if there are any follow up queries. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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