Inflammation of the spinal cord is called myelitis (from the Greek "mielos"). It is the immune response of the human body to an infectious attack, intoxication or traumatic cellular destruction of the nervous tissue. Depending on the width of the lesion and its location, the disease can break the connection between the body and the brain or permanently disrupt the control of the limbs and the functioning of the internal organs.
Varieties of myelitis are divided into two main groups, which are formed on the basis of the order of appearance of the lesion process:
- Primary. Pathology is the result of a direct lesion (infection, injury) of the patient’s spinal cord.
- Secondary. The disease develops against the background of another disease or is its complication (that is, a consequence of secondary infection).
There is a simultaneous inflammation of the brain and spinal cord.
There is a classification by the mechanism of occurrence of the process of inflammation. Depending on this, myelites are divided into the following categories:
- idiopathic (etiology unclear),
Infections of an infectious nature are produced predominantly by the hematogenous method, by means of the blood supply system (the only exception is infection in an open wound). The method of penetration of viral infections in myelitis of the primary type involves the direct entry of viruses through the bite of infected people and animals, blood-sucking insects, non-sterile medical instruments into the blood. The most likely causative agents of infectious primary myelitis are neurotropic (with the ability to infect neurons) viruses of tetanus, influenza, measles, chicken pox, rabies, mumps, depriving, polio, various types of herpes (cytomegalovirus, herpes simplex, Epstein-Barr). How else does spinal cord inflammation occur?
Provocative factors of secondary infection
Foci of infection of a secondary type infection appear in the spinal cord as well as a result of the movement of bacteria through the blood supply system. Such pathogens are known:
- fungal (Cryptococcus, Blastomyces, Aspergillus),
- bacteria (syphilis, tuberculosis),
- parasites (trematodes, helminths).
Traumatic sources of inflammation:
- radiation (high-energy radiation),
- electric shock,
- decompression sickness.
- pernicious anemia (neuronal death, demyelination, vitamin B12 deficiency), diabetes,
- chronic liver disease.
In addition to the above factors, the inflammatory process in the spinal cord can be triggered by toxic substances (including anesthesia during spinal intervention), collagenosis (diseases of the connective tissues), heavy metals, inflammation of the meninges (arachnoiditis), autoimmune diseases.
Inflammation of the spinal cord can be caused by the introduction of a vaccine for any of the above viral diseases.
The infection enters the spinal cord from the outside either by hematogenous or lymphogenous means from the primary focus (with lymph or blood). The second way of introduction is the myelin sheaths or the fibers of the nerves of the spinal cord.
First, there is an infection of the space between and under the membranes, then the main brain tissues are affected (white and gray matter).
The spinal cord has a division into segments that correspond to the size of the vertebrae. Each segment is responsible for reflexes and transmits signals from a specific muscle group or internal organ to the brain of the head and back. Depending on the number of infected segments, myelitis is defined as limited (localized), distributed into segments (disseminated) or focal (in unrelated or adjacent segments). Opticomyelitis is isolated separately when transverse myelitis and optic neuritis are combined, which is distinguished by demyelination.
According to localization in the brainstem, myelites are divided into:
- transverse (the affected area is white and gray matter of the brain in a number of segments at once),
- front (affected area - white matter in the zone of the median anterior furrow),
- peripheral (white matter of the brain is affected on the lateral and posterior sides),
- central (exposed gray matter).
The disease is determined by the intensity of the reaction as:
- Acutely developing rapidly, deep tissue damage, there may be several foci of development.
- Subacute. Slowly develops, accompanied by pains of unclear genesis, beginning from the lower parts.
- Chronic. For several years it develops, accompanied by defects in tissue nutrition. The main cause of the disease: the first type of T-lymphotropic virus and HIV infection.
The main result of the activity of cells of the immune system is neuronal degeneration and demyelination of the closest conducting nerves, which are involved in the sphere of the inflammation process. Necrotization of nerve tissue is manifested in the form of an increase in fragments of cell structures in the cerebrospinal fluid.
Inflammation of the spinal cord is expressed in the form of puffiness, tissue swelling, blurred border between white and gray matter (seen on MRI). If you greatly increase, then there are visible blood clots in the capillaries, microscopic hemorrhages, destruction of cell walls, the disintegration of the neuronal myelin sheath.
The disease more often (about 40% of cases) affects the thoracic vertebral part and the lower part of the spinal column. In terms of the frequency of infection, the second is the upper half of the chest, lower back and thoracic-lumbar joint. The neck is infected quite rarely. More often affected are the adjacent pairs of vertebrae or several departments at once (disseminated inflammations).
The symptoms and treatment of inflammation of the spinal cord are interrelated.
Symptoms of myelitis are clinically different. Their expression is determined by the degree and level of inflammation of the spinal cord. The main ones are as follows:
- sensitivity defects
- discomfort of pain,
- pelvic dysfunction,
The first symptoms of inflammation of the spinal cord are similar to signs of any infectious process: general weakness, chills, fever up to 39˚. The presence of a neurological pathology is indicated by back pain, which can spread to neighboring tissues from the affected area.
A strongly developed inflammation of the substance of the spinal cord leads to a loss of sensory and motor functions.
Recognize the infectious origin of acute myelitis can be on the basis of characteristic signs, confirm its neurological tests. To determine the less pronounced chronic and subacute forms, you can use visualization diagnostic methods.
Computed tomography using a contrast agent or magnetic resonance imaging are the leading imaging techniques. In addition, myelography is used (not such an effective type of fluoroscopy).
How is the pathogen determined?
The infectious pathogen is determined by bacteriological analyzes of CSF, studies of exudates and blood in the affected area. Spinal cord fluid samples are checked for lymphocyte count, protein content and physical changes. If neutrophils are in large quantities, this indicates the severity of the pathology.
Analyzes and symptoms can speak about diseases similar in development: malignant tumors, multiple sclerosis, epiduritis (epidural purulent abscess), arachnoiditis, polyneuropathy, encephalomyelitis. With the help of differential diagnosis, the diagnosis is specified.
It is desirable to treat spinal cord inflammation in a hospital or under constant medical supervision. The correct position of the human body in bed, continuous care will ensure minimal tissue and skin damage, as myelitis often becomes a cause of trophic disorders, which, in turn, provoke the occurrence of bedsores in a patient.
The processes of inflammation become stable and are reduced through hormonal medications (corticosteroids). Bactericidal and antiviral treatment (antibiotics, sulfonamides, immunostimulants) provides accelerated destruction of the infectious pathogen.
Procedures to improve trophism and blood circulation are made to prevent the appearance of pressure sores: ultraviolet irradiation, dressings with healing ointments, and washing the skin with potassium permanganate.
When gangrenous lesions appear, therapy is provided for surgery (necrotic tissue is excised).
With defects in urination, a catheter is inserted. To prevent diseases of the urinary system, antiseptic washing is performed regularly. Stimulating agents help the patient to strengthen the degrading muscle tissue. High tone and muscle contractures for paralysis of the spastic type are mitigated by muscle relaxants. Through the use of anticholinesterase drugs improves conductivity in motor neurons of nerve excitation.
Gymnastics and massage
Gentle gymnastics, as well as massage, improve muscles, reduce the tension of the ligament apparatus during inflammation of the spinal cord roots. During the recovery period after stabilization of motility defects, the patient is recommended to do exercises to restore the elasticity and mobility of the ligaments.
Reconstructive complex treatment of inflammation of the spinal cord involves physiotherapy: electrophoresis with biologically active substances and preparations, electrical stimulation in the vertebral region. In addition, balneological procedures are recommended (mud treatments, mineral baths).
Many factors influence the determination of pathology prognosis: the condition and age of the patient, the type of disease (secondary or primary, accompanied by other neurological disorders), the occurrence of the inflammatory process and infection. Positive dynamics prevails in the general statistics.
During inflammation of the spinal cord, its prognosis is determined by the location of the pathology, its form and the severity of the course. As a rule, doctors give a sharply negative prognosis only for meningococcal type of infection. Other species can be treated quite effectively.
The recovery process after inflammation of the spinal cord can take a long period. The patient is given a non-working second disability group with medical re-certification each year. It is believed that it is possible to fully restore mobility of the lower extremities after spinal cord myelitis literally 6-8 months after the onset of the disease. With transverse lesions of the spinal cord of a stroke-like character, paraplegia and paralysis can be preserved. It can also result in absolute recovery.
With a similar frequency, there are cases that are accompanied by a gradual progression of symptoms, eventually ending with a fatal outcome of the patient for 5-6 years. The most unfavorable prognosis, if the inflammatory focus is localized in the lumbosacral region. There is also a certain danger if the cervical region is affected.
The highest probability of recovery of the patient after myelitis is observed with timely medical care. When the patient turns to the doctor at the stage of loss of sensitivity in the extremities, the possibility of complete recovery will significantly decrease.
What is called inflammation of the roots of the spinal cord, now we know.
Currently, people are vaccinated, which protects them from infectious pathologies affecting the brain and spinal cord sheaths:
- poliomyelitis - an infection of the motor function of the vertebral cervical spine,
- measles - a disease whose symptoms are a rash in the mouth and on the skin, cough,
- Mumps is a virus that affects the salivary glands.
All other causes of the disease are difficult to predict and cannot be prevented. The most important thing is to be attentive to your own health, if something is disturbing, you need to seek help from doctors in time and not self-medicate.
We looked at the symptoms and treatment of spinal inflammation.
Acute focal myelitis Edit
It begins relatively sharply with malaise, general weakness. Then there is a fever with chills. Slight pain in the back, chest. There are paresthesias in the legs, which gradually turn into numbness with a rapid increase in the loss of movements, up to complete paralysis. Since the thoracic region of the spinal cord is affected most often develops lower paraplegia with loss of sensation of conductive type. With the acute development of the disease, paralysis at first has a sluggish character with loss of tendon reflexes. Over time, flaccid paralysis can become spastic. In the case of a non-acute process, paralysis can immediately become spastic. If the process is not localized in the thoracic spinal cord, then the picture of paralysis will be different. With inflammation in the half segment will be observed Brown-Sekara paralysis. There is also a disorder of the functions of the pelvic organs in the form of urinary retention and feces, or vice versa in the weakness of the sphincters.
Acute disseminated myelitis Edit
The disease develops acutely, symptoms of spinal cord lesions appear in the first days. In this case, the process is localized by lesions in different parts of the spinal cord, along with a large lesion at a certain level, there are a number of smaller foci of inflammation in different segments. Foci of inflammation are located in the white and in the gray matter of the spinal cord. They bring additional symptoms to the clinical picture of the disease: an increase in the knee reflex and the absence of Achilles with the simultaneous presence of certain pathological reflexes. The unevenness of the lesion is indicated by different intensity of motor, sensory and reflex disorders on the right and left. In such cases, there are mild pelvic organ disorders and blurred trophic disorders. Sensitive disorders can also be pronounced. Deep sensitivity may suffer more than superficial. This happens both in conductor and radicular type.
Subacute Necrotizing Myelitis Edit
Subacute necrotizing myelitis is usually recorded in elderly people with a chronic pulmonary heart. The clinical picture is characterized by a gradual increase in the symptoms of amyotrophic paraplegia, variable sensitivity disorders and pelvic disorders are noted. Damage to the lower parts of the spinal cord and the cauda equina tends to spread upwards and continues for several years.In the cerebrospinal fluid is marked protein-cell dissociation with moderate pleocytosis. Subacute necrotizing myelitis usually occurs as paraneoplastic syndrome. Almost half of the cases fail to establish the cause of the disease. Most often the inflammatory process in myelitis is localized in the lower thoracic region of the spinal cord.
Acute flaccid myelitis Edit
Acute flaccid myelitis is considered an extremely rare disease, resembling the symptoms of polio. OBM affects the gray matter of the spinal cord, and in some cases can cause lifelong muscle paralysis. Unlike poliomyelitis, there is no vaccine and drugs for the treatment and prevention of acute flaccid myelitis. The causative agents of the disease are unknown. US Centers for Disease Control and Prevention consider viruses, toxins, and genetic disorders as possible causes of illness. It is also noted that acute flaccid myelitis is not contagious and is not transmitted from person to person. In 2014, a noticeable increase in the number of cases of OSM was recorded for the first time. The peak incidence was in August — September. In 2018, the disease began to spread more rapidly. In October 2018, 127 cases of OBM were registered in the USA. Children under 18 years of age were exposed to the disease, with an average age of 4 years.
Symptoms of illness
Symptoms of myelitis appear incrementally. The patient's condition worsens every second. Among the main manifestations are the following:
- a sharp rise in body temperature
- severe chills, dizziness,
- muscle weakness
- back pain.
In the first days of the disease, symptoms characteristic of many diseases appear, then characteristic meningeal symptoms appear, but only a doctor can identify them and draw the right conclusions.
There are many varieties of myelitis, depending on the localization of the inflammatory process, the degree of damage to the spinal membranes. Each type of disease has its own symptoms. Back pain can occur in different areas and departments. Stage of development of the disease also has an important value. If at the initial stage the patient has a very bad back, he cannot tear his head and neck from a prone position, then after a couple of days paralysis of the limbs, incontinence of feces and urine occur.
Causes of the disease
Myelitis is primary and secondary. In the first case, the gray and white matter of the spinal cord is initially affected. In the second case, the inflammation is a consequence of other ailments. Often, the causative agents of myelitis are viruses and bacteria. For cancer patients characterized by the so-called radiation myelitis, which develops on the background of radiation therapy. It manifests itself after 6-12 months after the end of treatment of the underlying disease. Often, patients and physicians are ready for such an outcome, so the treatment of the inflammatory process begins in a timely manner, the therapy gives a positive result.
Severe hypothermia is another cause of myelitis. It is impossible to “catch cold” in the spinal cord, but under the influence of low temperatures the body’s immune response decreases, therefore viruses and bacteria penetrate faster into the membranes of the spinal cord and actively reproduce there.
Diagnosis of spinal inflammation
Diagnosed inflammation of the spinal cord in a hospital. First, the doctor examines the patient, collects anamnesis. General biochemical blood tests are prescribed. Elevated white blood cells, increased ESR - these are typical indicators in the acute period of the disease. An accurate diagnosis can only be made after spinal puncture. Examination of the cerebrospinal fluid allows not only to identify inflammation, but also its pathogens. It is determined which microorganisms are present in the fluid from the spinal cord, their sensitivity to antibiotics is checked in order to select drugs that will be effective during the treatment process.
Types of disease
Myelitis classification is extensive. To a greater degree, this knowledge is required by doctors in order to correctly diagnose the inflammatory process in the spinal cord, to determine the correct treatment strategy. Acute, subacute and chronic myelitis is distinguished by the duration of the course. What matters is the degree of damage to the spinal cord. Inflammation may be limited, common, focal. Separately isolated transverse myelitis. In this case, the inflammatory process develops in several, adjacent areas.
Equally important is the cause of the development of myelitis. Inflammation occurs under the influence of viruses, bacteria, ionizing radiation, injuries, strong toxins. In rare cases, it is not possible to establish the cause of the development of the inflammatory process. Then myelitis is more difficult to treat.
Features of treatment
Myelitis treatment is always carried out in a hospital. This problem is dealt with by a neurologist. It determines the localization of inflammation, the degree of damage to the white and gray matter of the spinal cord. The inflammatory process must be stopped. At the same time there is a struggle with the symptoms of myelitis.
Immediately appointed hormonal painkillers and anti-inflammatory drugs. In our country, active use of drugs based on prednisone. They are effective in treating myelitis. These drugs enter the body in the maximum allowable doses.
A patient with myelitis must be prescribed broad-spectrum antibiotics also in the maximum allowable doses. These drugs need to be taken, even if the cause of inflammation of the spinal cord has become a virus. Such actions are aimed at reducing the likelihood of serious adverse effects of myelitis.
Diuretics are necessarily taken to avoid tissue swelling. Often, when treating myelitis, the patient is already paralyzed, so additional measures are taken to avoid pressure sores.
Rehabilitation of patients after treatment
Myelitis is the most serious disease affecting the bone marrow. Everyone knows that this body is responsible for human immunity, because it is here that the production of leukocytes is carried out. Although modern medical technologies allow to treat myelitis, it is possible to completely eliminate the effects of inflammation of the spinal cord in units of cases.
Restoration of all functions and systems of the body is carried out within 1-2 years after the completion of the treatment of inflammation of the spinal cord. During this period, the patient is engaged in exercise therapy, passes reflexology courses. The final prognosis depends on the localization of inflammation, the degree of tissue damage. Patients are often given a disability group, but many return to normal life and even to work.
Who is affected by myelitis?
It is difficult to determine the signs of those groups of people who can get myelitis. Definitely impossible to determine the sex or age category of potential patients. However, a number of researchers, having studied these statistics, say: most often the pathology is observed in a rather young (from 10 to 20 years old) and old age.
Causes and classification
Depending on the order of occurrence of inflammation, the causes of myelitis fall into one of 2 categories:
- Primary - as a result of a direct negative impact on the spinal cord (infection, spinal injury),
- Secondary - when myelitis becomes a consequence of a complication of a pathology or appears on its background (repeated infection).
The infection enters the body either through the circulatory system or through an open wound. In this case, viruses of the neurotropic group (chickenpox, lichen, polio, herpes, mumps, influenza, measles, rabies, tetanus, etc.) are probable pathogens.
Secondary infection occurs due to:
- Various groups of fungi,
- Parasites (for example, trematodes or helminths),
- Some bacteria (pathogens of syphilis or tuberculosis).
The classification of this neurological disease, based on the mode of appearance, is as follows:
- Intoxication origin,
- Unspecified etiology (idiopathic).
There are also such cases when myelitis is caused by a violation of metabolic processes: anemia of the pernicious type, diabetes mellitus, and chronic liver diseases.
We advise you to read: spinal neuroma.
Any of the factors (trauma, infection), which is the cause of myelitis, causes not only inflammation, but also swelling of the spinal cord. This is the mechanism that triggers the development of the pathological process. Due to edema in the surrounding tissues, the blood supply is disturbed with the formation of blood clots in the vessels. This condition further increases the swelling. From this we can conclude that inflammation of the spinal cord, like many other neurological diseases, develops cyclically.
The deterioration of blood circulation, as well as its absence in certain areas, leads to softening and death of nerve cells and tissues of the spinal cord. The morphological structure of the affected area looks flabby and edematous, the shape of the butterfly characteristic of the spinal cord blurs. When examining the focus of necrosis under a microscope, such characteristic signs as myelin disintegration, severe edema, infiltration process, hemorrhage sites are seen.
After recovery, a scar formed from connective tissue is formed in place of the dead areas of the nerve fibers. Of course, due to the peculiarities of the cellular structure, the scar can not function as clusters of nerve cells, therefore, disorders that appeared during the period of the disease remain even after the patient is cured.
Clinical manifestations of myelitis are different, their severity depends on the level and degree of spinal cord injury. The main ones are:
- Unpleasant pain,
- Impaired sensitivity
- Pelvic dysfunction, etc.
The first signs are similar to the symptoms of any infectious process: chills, general weakness and fever up to 39 degrees. The presence of a neurological disease is signaled by back pain, which can spread from the affected area to neighboring tissues.
Strongly developed myelitis leads to loss of both motor and sensitive function of the spinal cord.
The choice of the therapeutic complex depends on the etiology of myelitis, the symptoms of the disease in a particular case, the characteristics of the development of the pathology and the general condition of the patient. Among the measures for the treatment of myelitis are considered effective:
- Administration of medications (fairly large doses of broad-spectrum antibiotics, uroseptics, analgesics, antipyretic drugs, muscle relaxants, anti-inflammatory drugs - mainly glucocorticoids),
- The complex exercise exercise,
- Percussion massage
- Physiotherapeutic methods of treatment (mainly UVB).
In case of urinary dysfunction, catheterization and lavage of the bladder are performed, and preparations of the anticholinesterase group are prescribed. Vitamin therapy is used to restore the functioning of nerve cells after the treatment and take vitamins of group B, it is recommended in the form of a solution for injection.
To prevent the occurrence of bedsores can be as follows: under the bony protrusions, you can put a special circle or cotton swabs, periodically help the patient to change the position of the body, rub the skin with a solution of soap and alcohol or camphor alcohol. In addition, apply the UV on the ankle, sacrum and buttocks.
Running stages lead either to death (inflammation in the cervical region), or to disability (myelitis of the thoracic and lumbar regions) of the patient. Therefore, it is important to undergo an examination and start therapy immediately.
If the pathology proceeds favorably, and the treatment is carried out correctly, the patient's recovery occurs a maximum after three months, and after a year or two the patient is fully restored. Timely prescribed and adequate sanitary and resort treatment can speed up these processes at times.
The causes of myelitis
Myelitis classification is based on the reasons for its origin. The main cause of inflammation of the spinal cord is a reduced activity of the immune system. This makes the spinal cord vulnerable to secondary damage. It is this process that causes the inflammatory process.
An immunodeficiency condition can also cause fatigue, nervous stress, chronic diseases of internal organs, thermal effects (hypothermia or overheating), viruses and infections, or the combined effects of several of these factors.
Acute myelitis may begin after lymphogenous (by lifmotok), hematogenous (by blood vessels) penetration or due to the appearance in the body of the following damage factors:
- Viral infections (viral hepatitis, cytomegalovirus, Epstein-Barr virus, Coxsackie, measles, rubella, mumps),
- Traumatic injuries of the spine and nerve tissue
- Compression (compression by tumor, or hernia),
- Toxic effects (acute or chronic poisoning with heavy metal salts, neurotoxins, carbon monoxide),
- Radiation exposure (or radiation of a tumor that caused damage in this area),
- Poor vaccination (most often of infectious-allergic origin),
- The failure of the immune system, which perceives the spinal cord as a foreign tissue, to which it produces antibodies,
Acute myelitis, extremely rarely can be caused by pregnancy and childbirth. Spinal cord inflammation is always preceded by a prodromal period characterized by common clinical symptoms such as weakness, fever, malaise, and lethargy. If in this state, consult a doctor, then the course of the lesion will be smaller.
Inflammation begins due to swelling of the spinal cord, which appeared due to these reasons. Further, blood supply is disturbed in the muscles and blood clots appear in the vessels. Swelling increases. This is the so-called "vicious circle." As a result, the tissue of the spinal cord softens. Many of the disorders that appeared in the body due to illness persist even after recovery.
Symptoms of spinal inflammation
The manifestation of myelitis depends on the location of the pathology. In the early days of the onset of the disease, the symptoms of myelitis resemble the general clinical picture of any serious illness and manifest as muscle weakness, dizziness, severe chills and a sharp rise in temperature. Around the same time, back pain begins.
A profile specialist can see behind the blurred picture the characteristic symptoms of transverse myelitis. These include increased painful sensitivity to light and loud sounds, jumps in intracranial and spinal pressure, vomiting without eating, and some muscle reflexes. Headache with inflammation is severe, with a tendency to increase. All this continues until the onset of focal symptoms, directly related to the level at which the inflammatory process in the spinal cord developed.
The prognosis and success of treatment depend on the location and degree of damage. Timely diagnosis by a qualified doctor is one of the main factors for effective treatment.
Myelitis of the cervical spine is accompanied by flaccid paralysis of the hands and spastic leg - bulbar disorders are possible, and the phrenic nerve and respiratory distress often occur.Pathology in this area of the spine is the most dangerous, as it can cause damage to the phrenic nerve and, as a result, stop breathing.
Affected thoracic section leads to dysfunction of the abdominal organs, paralysis of the legs, urinary retention and feces, turning into incontinence due to damage to the pelvic organs, and pathological reflexes are often manifested.
In the lumbosacral region with myelitis, paresis occurs in the legs and dysfunction of the pelvic organs. The muscles gradually atrophy due to nerve innervation and the lack of normal regulation.
When the inflammatory reaction in the spinal cord is a loss of sensitivity. It is typical for any place of localization of myelitis as well as a complete violation of the functions of the spinal cord.
Spinal cord myelitis (inflammation)
Inflammation of the spinal cord is a condition that is dangerous to human health and life. In the absence of timely medical care leads to permanent disability due to loss of mobility of the upper or lower extremities.
Spinal cord myelitis may develop under the influence of external and internal pathogenic factors. Very often, aseptic inflammation is diagnosed against a background of sequestered hernia (tearing off a portion of the pulpal nucleus and its slipping into the spinal canal.
It can also be an infectious lesion when a pathogen penetrates through the lymphogenous or hematogenous route. With penetrating wounds to the back and neck, an atypical form of the infectious agent may be recorded.
Less common cases of myelitis against tick-borne encephalitis.
In this material, we propose to analyze the typical symptoms of inflammation of the spinal cord and treatment methods, which make it possible to give a positive prognosis for recovery and full restoration of the mobility of the legs and arms.
In most cases, the appearance of symptoms of myelitis of the spinal cord leaves no doubt in the preliminary diagnosis, so after a special diagnosis, conservative medical treatment is quickly prescribed.
It is held at the initial stage only in a specialized inpatient setting. After discharge from the hospital, rehabilitation treatment is continued on an outpatient basis.
Why does this happen and what is the classification?
Nerve fibers, which are a thick bundle that creates a connection between the body and the brain, all represent the spinal cord. Inflamed, it is not that it weakens, but loses its functions more. So, if the pathways of the spinal cord are damaged and they provide movement of the hands, the person will have problems controlling his upper limbs. Pathologies of the pathways from the brain to the legs cause paralysis and weakness of the legs, and there is also the danger of disturbing the functionality of the gastrointestinal tract and urinary system.
Myelitis is classified according to different criteria. The simplest classification is considered to be based on the criterion for the development of the disease: primary and secondary. Secondary is different from the primary in that the progression of the disease occurs in conditions of any other diseases.
There is another grouping of myelitis - according to the etiology of the disease. It represents a variety of reasons for the development of this disease. Thus, there is bacterial, post-vaccination, viral, traumatic and toxic inflammation. A common case of spinal inflammation can be called primary infectious myelitis, the cause of which can be rabies and other illnesses.
Secondary cases of this disease are usually complications of serious infectious diseases, examples of which are typhoid, measles, scarlet fever and pneumonia. Also, people with blood sepsis are at risk of developing this type of pathology.
Considering the typology of the disease of the spinal cord further, I would like to mention that there is a classification by prevalence and development of the disease. In the first case, myelitis is diffuse, multifocal and limited. In the second case - acute, subacute or chronic.
If we talk about acute transverse inflammation of the brain, then this disease belongs to a limited type of myelitis, because there is only one focus of inflammation, which has a small size.
In addition to the above reasons for the appearance of myelitis, there are factors that contribute to the defeat of the spinal cord. Hypothermia is just one of them.
Myelitis is cervical, thoracic, and lumbar. With the development of the disease, the functioning of the nerve endings is disrupted, which subsequently causes serious problems in both the sensory and motor systems.
Note! An increase in body temperature of up to forty degrees, weakness, chills and gagging are the main signs of the acute form of the disease.
In myelitis, the first thing that the patient faces is paresis of the legs, arms and pain symptoms of moderate intensity. Following are motor and sensory disorders, which can occur within a few days. There are also frequent problems in the pelvic area (as a rule, we are talking about organ malfunction).
The characteristic of neurological manifestations varies depending on the period of progression of the degenerative process and on the location of the source of inflammation.
If inflammation is found in the lumbar region, the development of the disease occurs as follows: first, paresis of the legs, accompanied by muscle atrophy, appear. After this, the functions of deep reflexes are completely disturbed or destroyed. Then - incontinence of urine and feces occurs, which is a clear sign of the malfunctioning of the pelvic organs.
Speaking about the symptoms of the disease, you need to consider the time of its manifestation and development. From the onset of the disease to the development of its peak, the signs of myelitis alternate. Primary (initial) symptoms practically do not allow a correct diagnosis, because they are not very different from signs of other infectious diseases. Conventionally, the standard signs of a degenerative-dystrophic process are an unexpected onset, weakness, chills, and a rise in body temperature of up to forty degrees. After passing this stage, myelitis begins to show itself, and the first thing that starts to torment the patient will be pain in the back, which is intense. The peculiarity of this symptom in myelitis in the absence of focus in one place. Back pain also affects neighboring areas of the body. Often the pain radiates to the back, upper legs, or other nearby body parts. Over time, the signs gradually become clearer, and this can take a couple of hours, and several days or even weeks.
Myelitis therapy depends on the extent of the lesion. A lesion of the spinal cord in the upper cervical region is considered the most dangerous compared to other species, since there is a chance of a possible defeat of the phrenic nerve, which promises to stop breathing.
Important! The most "suffering" part of the spine with myelitis is considered to be the thoracic. It is the thoracic myelitis that is the true root cause of the development of spastic paralysis of the legs. This type of paralysis further leads to chronic convulsions.
Often the lesion is found in the lumbosacral region. Symptoms in this case are paresis of the legs, gradual muscle atrophy, as well as problems in the work of the pelvic organs.
It is important to note that the patient's sensitivity is always reduced regardless of the site of the development of inflammation. There is an unspoken rule according to which a sensitivity violation occurs: this happens just below the affected area. These problems lie not only in the fact that pain sensitivity disappears in a person, but also in a diminished response to temperature changes and touch, and there may also be "false sensations" in the form of "goosebumps."
The origin and development of spinal inflammation
As you know, some factors can trigger the appearance of myelitis. For example, it may be an infection, injury. This is where the anomalous process begins. Inflammation contributes to impaired blood circulation in the tissues, which leads to the appearance of blood clots in the vessels. They, in turn, lead to an increase in edema. Subsequently, it is for this reason that the tissues of the spinal cord soften and undergo necrosis.
At the end of rehabilitation, a scar is formed from the connective tissue in the affected area. It is not able to replace the nerve cells and function instead. Many of the difficulties that have arisen in the course of the development of the disease remain after the course of therapy.
The infection penetrates into the spinal cord from the outside or from the primary focus in a hematogenous manner (with blood or lymph). The second route of introduction is the fibers and myelin sheaths of the spinal nerves. First, the space under and between the membranes is infected, then the main brain tissues (gray and white matter) are affected.
The spinal cord is divided into segments corresponding in size to the vertebrae. Each segment controls the reflexes and transmits signals to the brain and back from a specific internal organ or muscle group. Depending on the number of infected segments, myelitis is defined as localized (limited), disseminated (distributed over all segments) or focal (in several adjacent or unrelated segments). Separately allocated opticomyelitis - a combination of transverse myelitis and optic neuritis, accompanied by demyelination.
According to localization in the brainstem, myelites are divided into:
- anterior (the lesion is white matter in the anterior midline furrow),
- transverse (lesion area - gray and white matter in several segments),
- central (gray matter is affected),
- peripheral (white matter is affected on the back and sides).
The cause of inflammation is the reaction of the immune system to the presence of a "pathogenic factor." According to the intensity of the development of the reaction, the disease is defined as:
- acute (rapid development, deep tissue damage, possible development in several foci),
- subacute (develops slowly, accompanied by unclear pain, starts from the lower segments),
- chronic (develops within a few years, is accompanied by a malfunction of the tissues. The main cause of the disease is HIV infection, T-lymphotropic virus type 1).
The main result of the activity of immune cells is the degeneration of neurons and demyelination of the proximal conducting nerves involved in the area of the inflammatory process. Necrotization of nerve tissue is manifested by an increase in fragments of cellular structures in the cerebrospinal fluid (CSF).
Inflammation is expressed in the form of swelling of tissues, swelling, blurred border between gray and white matter (MRI). Under a strong increase visible microscopic hemorrhages, blood clots in the capillaries, the destruction of cell walls, the disintegration of the myelin sheath of neurons.
The disease more often, up to 40% of all cases, affects the thoracic spine, the lower part. The second most common infection is the upper half of the thoracic region (25-27%), the thoracic-lumbar joint and the loin (15%). The cervical region is infected relatively rarely, in 6-7% of cases. More often, adjacent pairs of vertebrae or several sections are affected at once (disseminated lesions).
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Depending on the speed of development and localization in the brainstem, several typical symptomatic patterns are distinguished.
Acute disseminated or focal myelitis appears within 24 hours after infiltration of pathogens into the space of the spinal canal. The immune reaction is accompanied by symptoms typical for infectious diseases: a rise in temperature of up to 38-39 o, chills, sweating, malaise. Inflammation causes swelling of the affected segments, which is manifested in light scattered pains. Pain syndrome is reflected in the parts of the body with which the inflamed brain sectors are connected.
Disorders of sensitivity and ability to manage dependent parts of the body (paresis and paralysis) gradually develop. In accordance with the defeat of the violation can be asymmetric, selective. The most serious motor dysfunctions occur with transverse myelitis.
The defeat of the thoracic region is expressed in the encircling chest pains (damage to the roots of the spinal nerves is manifested). In the future, the ability to make respiratory movements is impaired. The blockade of the underlying segments is manifested in a loss of sensation in the lower body (including the internal organs), developing paralysis of the limbs (paraplegia) and impaired control of the organs of the genitourinary and digestive systems (in particular, excretory functions). Against the background of a violation of innervation, infectious lesions and inflammations of the organs of the urinary system can develop. Sources of infection can be bedsores, urinary tract, bacteremia.
Cervical myelitis in the spinal thickening in cases of massive acute development becomes the cause of quadriplegia (paralysis of all limbs), respiratory and heart rhythm disturbances. Flaccid paralyzes as the motor neurons block in the spinal cord and spinal nerves (diasimas) are transformed into spastic:
- increase muscle tone
- the inability to perform mechanical functions, reflex movements,
- reduced muscular strength.
In the development of acute myelitis, the following stages are noted:
- stage of acute development: rapid swelling of the affected segments, neurological symptoms (impaired reflexes, paresthesia, paralysis) - from 2 hours to 10-14 days,
- early recovery period: from the moment of stabilization of neurological symptoms - up to 6 months,
- late recovery period: up to 1.5-2 years from the completion of the previous stage,
- residual effects (impaired conduction of neurons): indefinite time.
Necrotizing Subacute Myelitis caused by infection-necrotic lesions of the membranes of the spinal cord (purulent meningitis). The disease develops slowly over several years. The ascent comes from the lumbar vertebrae in the thoracic region. The destruction of the motor neurons of the lumbar section of the spinal cord and the cauda equina is expressed in the growing paraplegia of the lower extremities, dysfunctions of the pelvic organs and the abdominal cavity. An analysis of CSF shows an increase in cellular fragments. The disease affects the elderly. A high percentage of deaths in the development of myelitis to the defeat of the thoracic spinal cord.
Opticomyelitis more common in Asia The lesion of the spinal cord (transverse myelitis) is accompanied by neuritis and demyelination of the optic nerves. The disease develops symmetrically (in both eyes). Symptoms: impaired peripheral vision, scotomas ("blind spots"), reduced vision to a complete loss.
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Etiology and pathogenesis
The primary pathogenesis of spinal cord myelitis can be based on intervertebral hernia sequestration with dorsal localization. When this occurs, the output of the entire gelatinous body of the pulposus nucleus or its part from the shell of the fibrous ring occurs.
This substance has a protein nature. Therefore, the immune system recognizes it as foreign and directs inflammatory response factors to the focus of its introduction.
Aseptic inflammation of the membranes of the spinal cord develops, leading to the appearance of marked neurological symptoms.
The type of myelitis and its prognosis depend on the type of pathological changes. Opticoneuro-meuritis is the least dangerous because it is characterized by a fairly calm course without marked paralysis and stem lesions.
Opticomyelitis occurs mainly in adults, it is not characteristic of children under the age of 7 years. Devika syndrome has a mild course with a locally limited single phase with a sharp deterioration and subsequent movement to the recovery of the patient.
The prognosis for life and recovery of all functions in these cases is always positive.
Secondary types of myelitis related to reactive types are common. Arise in response to strong infectious processes in other organs and systems.
The most common tuberculosis, measles, whooping cough and herpes forms of inflammation of the spinal cord. The etiology of this disease may be aseptic.
This is usually observed as a result of serious back injuries, often associated with compression of the vertebral bodies, their cracks, protrusions of intervertebral discs and other unpleasant pathological changes.
Transverse and other types of disease
With selective selective damage to the substance of the spinal cord by neurotropic forms of pathogens, primary myelitis begins. Typically, this type is due to a viral infection that spreads through the body through the blood or lymphatic fluid.
For the secondary type of spinal cord myelitis is characterized by infection of bacterial pathogenic microflora.
It can also be spread in a hematogenous manner, and it can also penetrate by contact when injured in violation of the integrity of the epithelial tissues of the back in the spine.
There are cases of the development of secondary myelitis of the spinal cord after a fall on dog and in the region of the spine a rather deep scratch has formed on the skin. She had already begun to scar when negative effects occurred in the form of characteristic symptoms of inflammation of the spinal cord.
In the initial diagnosis, the doctor must determine not only the factor of primary and secondary form of the inflammatory process. It is also important to record the type of the course of the disease. And it can be acute or chronic, subacute and recurrent. The next stage of classification is to determine the localization of the primary changes. Here are the following options:
- transverse myelitis of the spinal cord with involvement of nerve fiber sections parallel and transverse to each other in the destruction of tissues,
- a clearly limited local process is more often observed when disk hernia is intervertebral
- the disseminated or widespread species is distinguished by the diffuse localization of numerous foci of the inflammatory reaction,
- diffuse myelitis is the most dangerous form, capturing the entire back of the brain and quickly leading to damage to the brain stem.
There are other characteristics that are present in the plot of the medical diagnosis. It is necessary to indicate the place of presence of pathologists in relation to the spinal column. It can be cervical, thoracic, lumbar or sacral localization.
And for the appointment of adequate and effective treatment, it is important to establish the etiology of inflammation of the spinal cord, because not only the speed of recovery of the patient’s health, but often even his life depends on the correctness of etiotropic therapy. Therefore, it is necessary to know that the disease can be triggered by the following pathogenetic factors:
- infectious effects of various forms of bacterial, mycotic, viral and parasitic microflora,
- post-traumatic inflammation, especially associated with compression and separation of individual parts of the vertebral structure,
- radiation myelitis occurs after radiation therapy,
- the toxic form is a response to total intoxication in the body,
- vaccine-associated type,
- unspecified etiology or idiopathic.
All of these factors are essential for making a forecast and prescribing an effective and timely treatment of the disease.
The main causes of inflammation of the spinal cord
There are various reasons for the development of inflammation of the spinal cord, but myelitis may not always be due to the penetration of pathogenic microflora.
There are situations when, during the differential diagnosis of a patient, associated organic lesions of the spinal column structures were detected, which led to permanent injury to the dural sac of the spinal cord.
As a result, symptoms of sluggish myelitis with recurrent chronic pathogenesis developed.
The main causes of spinal cord myelitis may include the following factors:
- meningococcal infection, provoking the development of severe purulent forms, often diagnosed in children under the age of 10 years,
- complication of viral infections (coxsackie, influenza, herpes),
- spinal cord injury with comminuted changes in bone structure,
- radiation therapy during autosomal and oncological processes,
- vaccination response,
- allergic alertness of the body,
- metabolic disorders,
- immunodeficiency of primary and secondary forms,
- general asthenia and reduced vitality,
- stressful influence of negative environmental factors, for example, hypothermia or heat stroke.
The exclusion of the cause is the basis for the quick and successful treatment of this pathology. Therefore, it is important to always find negative factors of primary influence and, as far as possible, to completely eliminate them.
Clinical symptoms of inflammation of the membrane and roots of the spinal cord
In most cases, symptoms of inflammation of the spinal cord appear suddenly, without a prodroma stage. This period of acute primary symptoms can last from two weeks to a month.
At this time, the clinical symptoms of myelitis of the spinal cord can lead to disastrous consequences.
Sensitivity and mobility of lower or upper extremities are lost, severe pain and convulsions occur, body temperature rises sharply.
The next stage of myelitis inflammation of the spinal cord can last for about 5-6 months. During this period, the primary lost function is restored. Thus, patients begin to re-learn to walk, develop fine motor skills of hands, etc.
The success of the rehabilitation carried out at this time depends on the prognosis for the complete restoration of the damaged body function. This is followed by a late rehabilitation period, in the continuation of which there are still pathological changes. But by the beginning of the next stage of residual phenomena, usually all signs disappear.
The full recovery usually takes 2-3 years.
The clinical picture of myelitis develops according to the following scheme:
- in the first 3-4 days the patient is worried about general weakness with high body temperature and muscle pain,
- on day 5-6, paresthesia sites begin to form (lack of skin sensitivity),
- at the same time, the patient notes the manifestation of cramps, tingling in different parts of the body, trembling,
- a week after the onset of the disease, a clinic of secondary paralysis or paresis begins to form,
- at the same time, the intestine and bladder are impaired (patients may experience incontinence of urine and feces),
- lower or upper limbs lose their ability to move,
- there is a spasm of the muscles of the anterior abdominal wall (the abdomen becomes hard as a board) and intercostal muscles,
- severe back pain is present in the first 10 days, then the pain syndrome is completely leveled,
- the patient loses the ability for any movements,
- bedsores and trophic ulcers are formed.
Myelitis clinic can develop as rapidly (within 12 hours) or very slowly (within 30 - 40 days). In the secondary form of the disease, it is almost impossible to catch the point of onset of inflammation of the spinal cord. The beginning coincides with the moment of improvement of the main infection.
There are features of the clinical manifestations of various forms of this pathology. So, for the subacute course is characterized by the preservation of the health and functioning of all organs and systems. However, the patient experiences persistent back pain.
Increasing paralysis with fecal incontinence and arbitrary emptying of the bladder is characteristic of focal localization of the inflammatory process. And for diffuse myelitis, asymmetry of clinical signs is typical.
The stroke-like course is present only in transverse acute inflammation of the spinal cord; it is not characteristic of other forms of the disease.
For diagnosis it is necessary to take cerebrospinal fluid in order to identify its liquor composition and the presence of blood corpuscles in it. It is also possible to conduct seeding for bacteriological analysis. Myelography and X-ray of the spinal column allows you to establish the lesion of MRI and CT are needed to clarify the diagnosis.
Differential diagnosis should exclude tumor processes and consequences of traumatic effects. Guillain-Barre polyneuropathy, spinal stroke and epiduritis should be excluded. It is important to analyze borreliosis and tick-borne encephalitis. In the long term, they can give similar clinical symptoms.
Prognosis for spinal cord myelitis to restore leg mobility
The prognosis for spinal cord myelitis depends on the form of the pathology, the location of its location and the severity of the course. As a rule, doctors give a sharply negative prognosis only if the pus is a meningococcal form of the infection. All other species are quite successfully treatable.
The recovery process after myelitis of the spinal cord can take a long time. The patient is assigned the second non-working group of disability with annual medical re-certification. It is believed that the full restoration of leg mobility after spinal cord myelitis is possible already after 6-8 months from the onset of the disease.
Preservation of paralysis and paraplegia is possible with transverse inflammation of the spinal cord with a stroke-like course. The outcome is also possible in full recovery. And with a similar frequency, there are cases accompanied by a gradual progression of all clinical symptoms, ultimately leading to the death of the patient within 5-6 years.
The most unfavorable prognosis for lumbosacral localization of the inflammatory focus. There is also a certain danger in the defeat of the cervical region.
Myelitis - The common name for any inflammatory processes of the spinal cord. Symptoms directly depend on the level and degree of damage, most often it is pain (its irradiation), paralysis, pelvic disorder, impaired sensitivity, and others.
Diagnosis of myelitis includes a neurological examination and an assessment of parameters of the cerebrospinal fluid taken for analysis by lumbar puncture. Also, CT or MRI of the spinal cord and myelography may be prescribed.
Treatment includes the appointment of antibiotics, anti-inflammatory drugs, analgesics, muscle relaxants, as well as exercise therapy, massage and physiotherapy procedures.
Myelitis is the generic name for all inflammation of the spinal cord, which can affect both gray and white matter. That is, myelitis is called any spinal inflammatory process.
Depending on the form and prevalence of inflammation, the severity of symptoms can vary considerably, but the disease still remains quite severe. Myelitis gives a high percentage of complications and is difficult to treat.
This disease can hardly be called widespread, it occurs in no more than 5 cases per 1 million people.
It is impossible to single out any peculiarities in the structure of the incidence of myelitis, gender or age practically do not affect the risk of developing the disease. Some researchers cite evidence that most often myelitis occurs in people aged 10 to 20 years and elderly people.
Causes of the development and classification of myelitis
Sometimes it is not possible to establish the exact cause of myelitis, but in most cases, the main “trigger factors” are still known.
The only classification of myelitis used in clinical neurology is based precisely on etiology, that is, the cause of its occurrence.
According to this classification, there are three variants of the disease: infectious, traumatic and intoxication.
Infectious myelitis. Makes up almost half of all cases. This species, in turn, is divided into two groups: primary (if the infection initially penetrated only into the spinal cord) and secondary (if inflammation arose after the infection from other foci entered the spinal cord).
The causes of infectious myelitis are most often: herpes simplex virus type I and II, cytomegalovirus infection, mycoplasma, syphilis, HIV, enterovirus infections. More rarely, meningococcal infection and borellia may be the etiological factor.
Secondary infectious myelitis occurs predominantly in osteomyelitis of the spine and when the infection is carried with the blood.
Traumatic, intoxication and other types of myelitis. Intoxication myelitis occurs under the influence of poisons tropic to the cells of the spinal cord. Such inflammation can occur both in acute poisoning (for example, a number of drugs and psychotropic drugs), and in the chronic action of a toxic substance (most often it concerns harmful production).
Myelitis, caused by spinal injury, has two components. First, the direct mechanical action on the spinal cord inevitably leads to the violation of its functions. Secondly, when injured, microorganisms can enter the spinal cord through a wound.
In addition, spinal inflammation can be caused by some systemic diseases. Most often, you can meet myelitis on the background of multiple sclerosis (in this case, myelitis can rightly be called a symptom of the underlying disease), a number of autoimmune diseases and vasculitis.
Also, myelitis often develops as a component of paraneoplastic syndrome that occurs in the early stages of growth of a malignant tumor.
Pathogenesis of myelitis
A provoking factor — whether it is an infection or trauma — causes spinal edema. This can be considered the starting point from which the whole pathological process begins. Edema disrupts blood circulation in the tissues, vascular thrombi occurs. This, in turn, increases swelling.
The mechanism of development of myelitis is the so-called "vicious circle", so characteristic of many neurological diseases. Blood circulation disorder (or even its cessation in certain areas) eventually causes softening and necrosis of the spinal cord tissues.
After recovery, the place of necrosis is filled with connective tissue - a scar is formed.
Of course, the scar tissue cannot perform the functions inherent in the nerve cells, so many of the disorders that occurred during the illness can persist even after recovery.
Pathologically, the substance of the spinal cord looks puffy, flabby, the characteristic "butterfly" has fuzzy outlines. Microscopy reveals areas of hemorrhage, swelling, breakdown of myelin, and an infiltrative process.
The clinical picture of myelitis entirely depends on the location of inflammation.The level of damage is determined by segments or divisions of the spinal cord (each of which has several segments).
For example, myelitis can be thoracic, upper neck, lumbar, etc. As a rule, myelitis covers the segment of the spinal cord across the entire diameter, disrupting the operation of all conduction systems.
This means that both spheres are violated: both motor and sensitive.
Describe the symptoms of myelitis is given the time of their occurrence. From the onset of the disease to the height of the clinical manifestations of the disease vary considerably. The first signs of infectious myelitis are completely non-specific and differ little from other infectious diseases.
Acute onset, a sharp increase in body temperature to 38-39 ˚ C, chills, weakness - all the "standard" signs of any inflammatory process. Further, the disease begins to acquire its characteristic features. The first neurological symptom is usually back pain. It can be very intense (this is individual).
Pain in myelitis is not localized in one area: the pain spreads to adjacent areas of the body. Its irradiation (actually, the spread of pain) is a sign of damage to the roots of the spinal cord (sciatica). The pain can "give" in the back, perineum, thigh, etc. It all depends on the level of the lesion.
Symptoms become more pronounced over time, and in some cases this “evolution of symptoms” can occur over several hours or days.
As already mentioned, the myelitis clinic varies depending on the level of inflammation. Myelitis of the upper segments of the cervical spinal cord is characterized by spastic tetraparesis. It is most dangerous: there is always the likelihood of damage to the phrenic nerve. This, in turn, threatens to stop breathing.
The spread of inflammation from the upper cervical segments to the structures of the medulla oblongata can lead to bulbar disorders. Myelitis at the level of cervical thickening is manifested by a combination of flaccid paresis of the hands with spastic paresis of the legs. The lower segments of the cervical region are more often affected than the upper ones, and their inflammation is not so dangerous.
In some cases, it threatens with persistent motor impairments (as a rule, myelitis does not bear danger to life).
The thoracic region of the spinal cord suffers, perhaps, most often. The defeat of this area causes the development of spastic paralysis of the legs. The latter is a paralysis-tension. At the same time, the muscles acquire excessive tonus, and convulsions may appear.
The response to checking knee and Achilles reflexes in breast myelitis is always too active.
It is worth remembering that with a rapidly developing transverse myelitis, a reduced muscle tone may first be observed, then, after some time, the disorder acquires the character of spastic paralysis.
The lumbosacral spinal cord is also often affected by myelitis. Myelitis symptomatology of this localization includes peripheral paresis in the legs and a disorder of the pelvic functions of the type of incontinence of urine and feces. In parallel with this, the muscles that are innervated by the affected nerves, deprived of normal regulation and nutrition, gradually atrophy.
Impaired sensitivity is observed in any variant of myelitis. The only firm rule: this kind of disorder always occurs below the site of injury.
Sensitive violations are the reduction or absence of pain sensitivity, reduced reaction to touch, cold, etc.
Paresthesias may occur - “nonexistent sensations,” such as “goosebumps”, coldness or the sensation of wind.
There are no non-traumatic methods for the diagnosis of myelitis (of course, if you need to establish the exact cause, not a preliminary diagnosis). The most complete information is given by the lumbar puncture. In the acute process, CT or MRI of the spine and myelography are prescribed.
As a rule, anamnesis, knowledge of the symptoms and results of the analysis of the cerebrospinal fluid is quite sufficient for an accurate diagnosis.
Liquor puncture also makes it possible to conduct a differential diagnosis, that is, to clarify the diagnosis by comparing the data obtained with signs of similar diseases in the clinic.
Myelitis must be differentiated from Guillain-Barré syndrome, hematomyelia, epiduritis, tumors, and acute impairment of blood circulation in the spinal cord.
Myelitis - a description of the disease
The causative agent and / or its toxins penetrate into the spinal cord and provoke inflammation in the latter. In this case, the bodies and processes of nerve cells are affected, the membranes, nerve trunks and roots can be damaged.
In neurology, there are several types of spinal cord myelitis, each of which has its own symptoms, severity of manifestations and prognosis.
For example, opticoneuroma myelitis (opticomyelitis, Devika’s disease (syndrome)) is atypical for children, and if it develops in children, then, unlike adults, it has a relapse-free single-phase character, and also has a favorable prognosis.
On the other hand, before mass vaccination in children, much more often than adults, such a pathology as poliomyelitis, provoked by a particular virus and having a high probability of death and disability, occurred.
Diseases that are common at this age play an important role in the development of secondary myelitis pathology in children: measles, whooping cough, chicken pox and others.
Causes of myelitis
Purulent myelitis ? This is a bacterial infection, most often triggered by meningococcus.
Nearly 40% of cases of the disease are in the viral forms of the disease caused by the viruses of Coxsackie, influenza, rabies and others.
Traumatic myelitis ? a consequence of spinal injury with subsequent complication.
The result of chemical poisoning (lead, mercury, etc.)? toxic myelitisin which nerves and nerve roots are often affected as well.
Has an allergic nature post-vaccination myelitis, which develops after vaccination in the presence of a certain predisposition (including VAP (vaccine-associated polio) when using the oral form of the vaccine).
Radiation therapy for cancer of the pharynx, larynx, esophagus, etc. may provoke development myelitis.
In the case when it is impossible to establish the cause of pathology, they talk about idiopathic myelitis. It is assumed that the main factor in the development of such episodes is the failure of the immune system.
- weak immunity
Symptoms and signs of spinal myelitis
Myelitis process consists of conditional stages:
- acute manifestations
- early restorative (lasts about six months from the moment of stabilization of the state),
- late restorative (up to two years),
- residual manifestations (two years later).
Symptoms of primary myelitis change this way:
- first there is a prodromal period (two to three days) with flu-like signs (muscle aches, general poor health, fever, headaches),
- then tingling, "goosebumps" in the limbs, encircling pains,
- as pain decreases, signs of spinal lesions increase (weakness in the legs, decreased sensitivity, tension in the abdominals, flatulence, difficulty defecation and urination),
- then there is a rapid development of trophic ulcers, pressure sores (almost regardless of the quality of patient care).
A similar picture may develop in a couple of minutes, but there is also a gradual increase in signs over the course of a month or even longer.
The most difficult course? in the lower thoracic, lumbosacral, cervical myelitis.
Signs of secondary myelitis may appear at the peak of the underlying disease or already during recovery. So, with chickenpox, deterioration due to myelitis may occur on the 3rd - 5th day, for measles - the 5th? 7th.
In a chronic primary process, myelitis may develop at any stage. Secondary myelitis has a subacute course and negative manifestations increase over the course of weeks.
Features of manifestation for different types
Symptoms acute transverse myelitis with stroke-like development, they are characterized by reduced muscle tone (lethargy) for a couple of weeks. If the disease does not progress quickly, then the dysfunction of the pelvic organs occurs later.
Acute focal myelitis:
- there is a slight soreness in the back and chest with a general deterioration of health,
- sensitivity is disturbed in the legs, numbness, tingling, "goosebumps" are felt,
- urinary and / or feces incontinence or difficulty urinating and / or urinating develop.
For acute common myelitis characteristic:
- unevenness of symptoms from different sides of the body,
- minor disorders of the pelvic organs.
Chronic, as well as subacute, form has the following features:
- weak back pains in violation of general well-being,
- the development of pathology below the localization of lesions,
- violation of the sensitivity and function of the pelvis, paralysis,
- mild paralysis at the onset of the disease and their subsequent progress to a spasmodic state,
- malnutrition and blood supply to tissues with the formation of pressure sores,
- joining bakinfektsii, blood poisoning.
When radiation myelitis:
- the first signs are noted after 6 - 48 months from the moment of irradiation,
- symptomatic type depends on the location of the lesion,
- predominantly impaired limb function.
Myelitis is differentiated from:
- traumatic compression of the spinal cord,
- metastatic spinal lesions,
- spinal stroke and / or arachnoiditis,
- Guillain-Barre polyneuropathy,
- epidurit and so on.
Myelitis is treated in a hospital.
- antibacterial agents
- glucocorticosteroids (prednisolone in a daily dosage of up to 120 g) in viral, allergic and idiopathic forms,
- adrenocorticotropic hormones,
- potassium orotate,
- anticholinesterase drugs, often with muscle relaxants with increased tone,
- diuretics (furosemide, etc.),
- antipyretic in case of fever,
- analgesics (non-narcotic, narcotic),
- glucose with hexamine.
In case of paralysis resulting from increased tone, thermal procedures (baths, paraffin, etc.) are shown, and in case of flaccid paralysis electrostimulation is shown.
- ensuring continuous emptying of the bladder,
- pressure sore warning
- Mechanical ventilation for respiratory muscle paralysis
- orthopedic styling.
At the end of the acute stage are held:
- vitamin therapy (may be prescribed in the acute period),
- physiotherapy (UHF can be used at the beginning of the disease),
- complexes exercise therapy,
- treatment in sanatoriums, resorts.
In the last stage of the disease, with marked motor impairment due to high tonus, a neurosurgical operation can be performed.
At the acute stage, surgical therapy is implemented with:
- presence of purulent foci,
- significant manifestations caused by compression of the spinal cord.
Nontraditional treatment of myelitis
Myelitis treatment with folk remedies is carried out after consultative communication with a doctor and includes compresses:
- from potatoes with honey,
- on the neck of a mixture of vodka, mustard, aloe, propolis.
Homeopathic treatment is carried out by a specialist in this field on the basis of the observed manifestations (prescriptions are adjusted as symptoms change) and the patient’s characteristics. Described episodes of use for myelitis Picricum acidum, Lathyrus sativus, Alumina in the required dilution.
Hirudotherapy also belongs to non-traditional methods of treatment of myelitis.
The video shows what leeches treat and how a hirudotherapy session will help:
Prediction and recovery after illness
Myelitis can develop with:
- stabilization and gradual reduction of symptoms,
- preservation of manifestations for life without deterioration (typical for acute transverse myelitis),
- the progression of pathology, the spread of inflammation to the lower part of the brain.
Myelitis of the lower thoracic and lumbosacral (due to impaired pelvic functions), as well as cervical (due to the proximity of the muscles responsible for breathing, etc.) - the prognosis is poor.
Purulent myelitis often ends in death.
Implications and preventive measures
Severe spinal damage in purulent forms of the disease leads to paralysis of the arms and / or legs.
Even after a mild course of pathology, violations of sensitivity, leg cramps, problems with motor actions persist.
The common complications of myelitis include the formation of pressure sores and impaired mobility of the joints of the injured limb.