acute myelitis
Introduction
Introduction to acute myelitis Acute myelitis refers to a non-specific inflammatory lesion of the spinal cord, which occurs mostly after infection. Inflammation often involves the gray matter of several medullary segments and the surrounding meninges, and is most susceptible to invasion by the thoracic cord. Symptoms of spinal cord damage. After the onset of some patients, the level of sputum and sensory disturbances continues to rise, eventually spreading to the upper cervical cord and causing quadriplegia and respiratory muscle paralysis, and can be accompanied by high fever, endangering the patient's life safety, called ascending myelitis. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: Acne
Cause
Cause of acute myelitis
Virus infection (80%):
The cause is unknown, may be due to certain viral infections, or an organism's own immune response after infection. Inflammation can affect different parts of the spinal cord, but the upper chest is most common. The spinal cord of the lesion was swollen, congested and softened, and the soft meninges were congested and turbid. The gray matter of the spinal cord was unclear, and spotted hemorrhage was observed. Microscopic dural congestion and inflammatory cell infiltration were seen under the microscope. In severe cases, the spinal cord is softened and necrotic, and spinal cord atrophy and scar formation may occur later.
Vaccination (3%):
Acute myelitis caused by vaccination is rare, mainly after the vaccine enters the human body as a foreign body, and the human body produces an autoimmune reaction, and the spinal cord develops inflammatory reactions such as swelling, redness, and congestion.
Prevention
Acute myelitis prevention
Prevention of complications:
1 Turn over, shoot back, prevent hypostatic pneumonia, and keep your limbs functional.
2 Place a balloon around the bone bulge, massage the skin, and move the limbs.
3 skin redness with 70% alcohol sputum, coated with 3.5% benzoin; partial acne dressing, strengthen nutrition; avoid hot water bag to prevent burns.
4 urinary dysfunction indwelling catheterization, to prevent urinary tract infection; dysphagia should be placed in the stomach tube.
Early rehabilitation training contributes to functional recovery and improved prognosis.
Prognosis is related to the severity of the condition
1. Those who have no comorbidities can recover from 3 to 6 months, and take care of themselves.
2. EMG was still denervated after 6 months of complete paraplegia, MRI showed extensive intramedullary changes, and lesions >10 spinal segments were poor prognosis.
3. Combined urinary tract infection, acne and pneumonia affect recovery, legacy sequelae.
4. Acute ascending myelitis and high cervical spondylitis have a poor prognosis and can die of respiratory and circulatory failure in the short term.
5. About 10% of patients develop multiple sclerosis or optic neuromyelitis.
Complication
Acute myelitis complications Complications
Complications such as hemorrhoids, lungs or urinary tract infections can often occur.
Symptom
Acute myelitis symptoms Common symptoms Spiral shock, weakness, reflexes, reflexes, reflexes, disappearance, dysarthria, dehydration, diarrhea, dysphagia, sensation, urinary incontinence
More common in young adults. A few days before the illness or 1 to 2 weeks, there may be a history of fever, general malaise or upper respiratory tract infection. Acute onset, often have back pain or chest and waist belt sensation, followed by numbness, weakness and other symptoms, symptoms develop to peak in more than a few hours to several days, the symptoms of transverse spinal cord injury.
First, movement disorders:
Paraplegia caused by damage to the thoracic cord is most common. For example, the cervical spinal cord is damaged by quadriplegia and may be accompanied by respiratory muscle paralysis. In the early stage of spinal cord shock, flaccid paralysis, decreased muscle tone, deep reflex disappeared below the pathological level, and pathological reflexes could not be induced. Usually after 2 to 3 weeks, gradually transition to spasticity, muscle tension is gradually increased, especially the extensor muscle tension is more obvious, deep reflex appears and then hyperthyroidism, pathological reflex is obvious, and sometimes muscle strength may begin to Recovery, recovery usually takes weeks and months, but in the end there are often some residual signs. If the lesion is heavy, wide-ranging or complicated with complications such as urinary tract infection, the stage of spinal cord shock may be prolonged, and some may be characterized as flaccid paralysis for a long time, or paralyzed limb paralysis after the spinal cord shock period. Increased muscle tone, slightly irritating, flexion of the lower extremities, accompanied by sweating, vertical hair reaction and automatic discharge of the bowel movements, called the total spinal cord reflex. The above situation often indicates a poor prognosis, and some patients may be disabled for life.
Second, the sensory barrier:
All kinds of sensations of limbs and trunks under the plane of damage are impaired. The severe cases disappear completely, and the double spinal cord thalamus bundle and the posterior cord are damaged. There may be a sensory allergy zone on the upper edge of the sensory missing area.
Third, autonomic disorders:
During the spinal cord shock period, due to the inhibition of the function of the medullary urination center and its reflex, urinary function loss, urinary retention, and no feeling of urine filling of the bladder, detrusor relaxation, and a loss of tension bladder, urine volume can be Up to 1000ml or more; when the bladder is overfilled, the urine is involuntarily overflowing, which means filling urinary incontinence. When the spinal cord shock period, due to the inhibition of the brain's urinary tract urinary center, the urinary reflex is hyperthyroidism, a small amount of urine in the bladder can cause detrusor contraction and involuntary urination, which is called reflex incontinence. If the lesion continues to improve, you can gradually restore the ability to urinate freely. In addition, there are constipation in the spinal cord shock period, damage to the body below the plane without sweat or sweat, dry skin, pale, cold, vertical muscles can not contract; after the shock period, skin sweating and skin temperature can be improved, standing hair reflex Can also be enhanced. If the cervical spinal cord disease affects the ciliary visceral medullary center, the Horner's sign may appear.
Examine
Examination of acute myelitis
The total number of white blood cells around the acute phase can be slightly increased. Cerebrospinal fluid pressure is normal, except for severe swelling of the spinal cord, there is generally no spinal obstruction. The total number of cerebrospinal fluid cells, especially lymphocytes and protein, can be increased to varying degrees, but it can also be normal. The cerebrospinal fluid immunoglobulin content can also be abnormal.
Electrophysiological examination
1 visual evoked potential (VEP) is normal, can be identified with optic neuromyelitis and MS.
2 The lower extremity somatosensory evoked potential (SEP) amplitude can be significantly reduced; motor evoked potential (MEP) abnormality, can be used as an indicator of efficacy and prognosis.
3 EMG showed denervation.
2. Lumbar puncture: The neck test is unobstructed. In a few cases, the spinal cord edema may not be completely obstructed. The CSF pressure is normal, the appearance is colorless and transparent, the number of cells, protein content is normal or slightly increased, lymphocytes are predominant, sugar and chloride are normal.
3. Imaging examination: normal X-ray film of the spine, MRI typical showed thickening of the spinal cord in the lesion, multiple flaky or spotted lesions in the intramedullary segment of the lesion, T1 low signal, high T2 signal, uneven intensity, may have Convergence, some cases can always be abnormal.
4. Laboratory examination: The total number of white blood cells around the acute phase may be slightly increased. Cerebrospinal fluid pressure is normal, except for severe swelling of the spinal cord, there is generally no spinal obstruction. The total number of cerebrospinal fluid cells, especially lymphocytes and protein, can be increased to varying degrees, but it can also be normal. The cerebrospinal fluid immunoglobulin content can also be abnormal.
Diagnosis
Diagnosis and differentiation of acute myelitis
Diagnostic criteria
Diagnostic criteria developed by the 2002 Collaborative Group on Acute Transverse Myelitis
1. Diagnosis contains conditions
(1) Progressive spinal cord sensation, exercise, and autonomic dysfunction.
(2) Symptoms or signs on both sides (not necessarily symmetrical).
(3) A clear sensory plane.
(4) Except for oppressive lesions (MRI or myelography; if the condition does not have a feasible CT examination).
(5) suggesting the manifestations of spinal cord inflammation: increased cerebrospinal fluid lymphocytes, increased IgG synthesis rate or enhanced scan enhancement; if there is no such performance at the beginning, MRI and lumbar puncture can be reviewed on days 2-7.
(6) The peak is reached within 4 hours to 21 days after onset.
2. Conditions to be excluded
(1) History of exposure to spinal cord radiation within 10 years before onset.
(2) The extent of the lesion conforms to the distribution of spinal cord blood vessels, such as the anterior spinal artery syndrome.
(3) Abnormal airflow signal on the surface of the spinal cord suggests spinal arteriovenous malformation.
(4) Serological or clinical manifestations suggest connective tissue disease (sarcoidosis, Behcet's disease, Sjogren's syndrome, systemic lupus erythematosus, mixed connective tissue disease, etc.).
(5) The manifestations of central nervous system infectious diseases, such as syphilis, Lyme disease, AIDS, mycoplasma and viral infections.
(6) MRI abnormalities suggest multiple sclerosis or clinical manifestations of optic neuritis.
Optional Auxiliary Examination: The preferred examination is spinal MRI and cerebrospinal fluid examination. Typical MRI showed thickening of the spinal cord in the lesion, and multiple flaky or spotted lesions in the intramedullary segment of the lesion, showing T1 low signal, high T2 signal, uneven intensity, and fusion. However, some cases can always be abnormal. Cerebrospinal fluid pressure is normal or increased, and if the spinal cord is severely swollen and obstructed, the neck test is abnormal. The appearance of cerebrospinal fluid is colorless and transparent, the number of cells and protein is normal or slightly increased, lymphocytes are dominant, and sugar and chloride are normal.
Differential diagnosis
1. Spinal vascular disease: The anterior spinal artery occlusion syndrome is easily confused with acute myelitis. Root pain often occurs in the lesions, paraplegia, painful temperature loss, and urinary dysfunction occur in a short period of time, but deep feeling remains; less spinal cord hemorrhage See, mostly caused by trauma or spinal vascular malformation, the onset of sudden onset of severe back pain, limb paralysis and urine retention. It can be identified by spinal nerve magnetic and cerebrospinal fluid examination.
2. Acute spinal cord compression: spinal tuberculosis or metastatic cancer, causing vertebral destruction, sudden collapse and compression of the spinal cord, and transverse spinal cord damage. It is easier to identify by nuclear magnetic.
3. Acute epidural abscess: history of purulent lesions and infection, tenderness in the lesion. Lumbar puncture has obstruction, peripheral blood and cerebrospinal fluid leukocytes increased significantly, cerebrospinal fluid protein content increased significantly, MRI can assist diagnosis.
4. Acute inflammatory demyelinating polyneuropathy: limbs are delayed sputum, terminal type sensory disturbance, may be associated with cranial nerve damage, sphincter dysfunction is generally rare. Spinal MRI is normal, cerebrospinal fluid protein cells are separated, and EMG nerve conduction velocity is slowed down.
