[Neurogenic bladder caused by hemorrhagic necrotizing myelitis].

Objectives: To report one case of flank pain irradiated to lower extremities, progressive paresthesias and functional difficulty leading to functional impotence of the lower limbs, and difficult voiding.

Methods: Neurologic physical examination showed abolished osteotendinous reflexes, indifferent plantar, L1 hypoesthesia, L3 anesthesia, and lower limbs hypotony. Multiple complementary exams were performed to get the final diagnosis of hemorrhagic necrotizing myelitis by MRI, after differential diagnosis with cavernous haemangioma. We performed a bibliographic search in Pub-Med (MEDLINE) using the terms "bladder, neurogenic (MESH) and myelitis (MESH)". Most publications correspond to case reports and prospective studies of cases of acute myelitis of different etiologies (arteriovenous malformations, multiple sclerosis, neoplasia, sarcoidosis, HIV infection, spinal cord compression,...) reviewing the diagnostic and therapeutic procedures.

Results: Neurologic examination, imaging studies and analytical determinations in cerebrospinal fluid (CSF) and blood were conclusive to confirm the level of the lesion and the most probable etiology in both the present case and those provided by the literature. Urodynamic study showed a neurologic bladder both at 4 and 24 months, being this the main sequel in our patient. The clinical repercussion derived from the level of the lesion improved in relation to walking and muscular balance, but the voiding condition persisted with bladder hyperreflexia and dyssynergia.

Conclusions: The clinical picture alerts about spinal involvement. Radiological tests, supported by analysis, allow to identify the level of the lesion, and in many cases the cause. Bladder dysfunction is common in acute myelopathies, and urodynamic studies help to label the picture and manage it.