tuberculous myelitis
Introduction
Introduction to tuberculous myelitis Tuberculous myelitis (tuberculous myelitis) is caused by the blood circulation of tubercle bacilli in other parts of the body (such as lungs, kidneys, bones, etc.) or direct infiltration of spinal tuberculosis, which involves the meninges at the same time. Tuberculous meningeal myelitis. basic knowledge Sickness ratio: 0.05% Susceptible people: more common in young adults Mode of infection: respiratory transmission Complications: retinitis
Cause
Causes of tuberculous myelitis
(1) Causes of the disease
The pathogen is Mycobacterium tuberculosis. Tuberculosis affects the spinal cord, the meninges and spinal cord blood vessels through blood or direct invasion, forming tuberculous granuloma or tuberculosis, causing meninges, spinal arachnoiditis and spinal cord ischemia.
(two) pathogenesis
Thoracic and lumbar spinal cord involvement is more common, mainly in the spinal cord, may be single or multiple tuberculous granuloma or tuberculosis in the intramedullary, severe cases may be associated with cavity formation, mainly due to meningeal involvement, often The meninges and nerve roots are thickened, in addition to tuberculous meningitis or vasculitis, followed by spinal cord vascular compression or obstruction of spinal cord ischemia, resulting in pathological changes in spinal cord ischemic injury.
Prevention
Tuberculosis myelitis prevention
The main principles are to enhance physical fitness, pay attention to prevent respiratory infections; strengthen management and treatment of TB patients; newborns and children actively implement planned immunization as required; early comprehensive treatment to reduce complications and sequelae.
Complication
Tuberculous myelitis complications Complications
1. Systemic tuberculosis.
2. Tuberculous spinal arachnoiditis can manifest as high intracranial pressure syndrome.
Symptom
Tuberculous myelitis symptoms Common symptoms Weight loss, night sweats, sensory disturbances, spinal cord intermittent breaks, spinal cord infiltration, low heat, anorexia, Mycobacterium tuberculosis, blood dissemination
1. More common in young and middle-aged, there may be a history of tuberculosis exposure or tuberculosis before the disease.
2. Usually slow onset, in the presence of spinal cord symptoms, there are low fever, anorexia, weight loss, night sweats and so on.
3. Spinal cord damage is often incomplete, with paralysis of the limbs below the level of the lesion, sensory disturbances and dysfunction of the bowel and bladder.
4. When the lesion is mainly caused by meningeal and spinal arachnoid lesions, root pain is the main manifestation, and dispersity, asymmetry, segmental sensory disturbance appear, and the clinical manifestation is similar to spinal arachnoiditis.
5. Blood routine examination is generally normal, erythrocyte sedimentation rate increases, the number of cells in cerebrospinal fluid is slightly increased, mainly monocytes, protein is increased, sugar and chloride are decreased, cerebrospinal fluid dynamics examination can be found that the spinal canal is patency or partial obstruction.
According to the history of tuberculosis, chronic or subacute onset of spinal cord and/or meningeal lesions, special cerebrospinal fluid changes, X-ray and spinal MRI images, the general diagnosis is not difficult.
Examine
Tuberculous myelitis
Blood routine examination
Generally normal, peripheral blood leukocyte counts are normal or slightly elevated; erythrocyte sedimentation rate is increased.
2. Cerebrospinal fluid examination
The number of cells in the cerebrospinal fluid is slightly increased, and the number of white blood cells is tens to hundreds, mostly mixed. The dominant one is mononuclear cells, which accounts for 85%, the protein content is light, moderately increased, and sodium chloride and glucose are decreased. Cerebrospinal fluid dynamics examination can be found that the spinal canal is unobstructed or partially obstructed, and the appearance can be frosted glass. The white fiber film can be formed after being placed for several hours. The direct smear of the membrane is more susceptible to the discovery of Mycobacterium tuberculosis.
3. Basis for pathogens
(1) The detection rate of CSF bacterial smear and bacterial culture is low.
(2) Skin tuberculin test.
(3) Early diagnosis: Polymerase chain reaction (PCR) is used to detect the DNA of tuberculosis in CSF.
In addition, enzyme-linked immunosorbent assay (ELISA) can be used to detect tuberculosis antibodies in CSF. The simultaneous application of the above two tests can improve the reliability of diagnosis, but attention should be paid to the possibility of false positives and false negatives.
4. Chest radiographs can be seen in active or old tuberculosis lesions. Some patients have spinal tuberculosis or tuberculous paraspinal abscess. These patients have more typical spinal tuberculosis changes in the spine X-ray: vertebral body destruction, posterior spine and angulation Malformation, formation of paraspinal cold abscess.
5. MRI findings of tuberculosis in the spinal cord
Involved spinal cord swelling, tuberculosis in T1 is equal or low-signal lesions, low in T2, etc., high-signal lesions, after injection of contrast agent, there is lesion edge or lesion nodular enhancement, spinal membrane, spinal arachnoid involvement MRI showed thickening of lumbar nerve roots and disappearance of subarachnoid space. After injection of Gd-DTPA, the nerve roots and spinal cord surface showed a linear signal enhancement; the dura mater and arachnoid plaque signal enhanced.
Diagnosis
Diagnosis and diagnosis of tuberculous myelitis
However, it is still clinically necessary to distinguish from spinal arachnoiditis and other subacute myelitis.
The symptoms of spinal arachnoiditis often fluctuate, the spine X-ray film is normal, the cerebrospinal fluid protein can be slightly elevated, but the sugar and chloride are normal.
Cerebrospinal fluid changes in chronic or subacute pyogenic myelitis are extremely difficult to identify with tuberculous myelitis and should be identified by medical history and spinal MRI.
