acute suppurative myelitis
Introduction
Introduction to acute suppurative myelitis Acute suppurative myelitis (acutesuppurative myelitis) is extremely rare, caused by acute spinal inflammation after acute suppurative infection, this disease often complicated with intraspinal abscess. It can be sick at any age, and it is most common in 20 to 50 years old. This disease involves the thoracic spinal cord. It initially has chills and fever, root pain, and rapid development into paraplegia. The peak of symptoms is usually reached within a few days. basic knowledge The proportion of sickness: 0.003%-0.007% Susceptible people: the most common 20 to 50 years old Mode of infection: non-infectious Complications: paraplegia spinal cord injury
Cause
Causes of acute suppurative myelitis
(1) Causes of the disease
Immediately due to infection of adjacent spinal cord tissue, such as open-ended infectious wounds caused by spinal gunshot wounds; also through blood-borne infections, such as from intrathoracic infections, endocarditis, gingival or periodontal abscesses, after uterus or appendicitis As well as swelling of the buttocks, etc., causing acute spinal cord inflammation.
A small number of cases are iatrogenic infections, caused by neurosurgery, and very few cases are caused by invasive diagnosis and treatment of the central nervous system.
(two) pathogenesis
Spinal cord adjacent to the tissue after acute suppurative infection involving the spinal cord, acute spinal cord swelling, softening, congestion, leukocyte infiltration; spinal cord neuronal degeneration or disappearance, microglia hyperplasia.
After the acute phase, the intraspinal abscess can be gradually formed, and the wall of the abscess can be formed. There may be mild or moderate inflammatory cells around it. The upper and lower conductive fibers in the spinal cord can be dystrophic due to neuronal axon transport. And degenerate.
Prevention
Acute suppurative myelitis prevention
1. Prevention of spinal cord adjacent tissue infection involving the spinal cord.
2. Strictly implement the routine of diagnosis and treatment to prevent iatrogenic infections caused by neurosurgery and diagnosis and treatment operations.
Complication
Acute suppurative myelitis complications Complications, paraplegia, spinal cord injury
It can cause damage to the spinal cord or nerve roots, leading to paralysis of the tendon and urine, and damage to different parts of the spinal cord, resulting in paraplegia in different planes.
Symptom
Acute suppurative myelitis symptoms common symptoms, paraplegia, chills, nerve roots, stimulation, abscess, hyperthermia, spinal cord intermittent break
This disease involves the thoracic spinal cord. It initially has chills and fever, root pain, and rapid development into paraplegia. It usually reaches the peak of symptoms within a few days. It is completely missing under the plane of damage, and has sphincter dysfunction, meninges and spinal nerves. Root irritating symptoms are obvious.
Laboratory examination showed that the white blood cells in the peripheral blood were significantly increased, mainly neutrophils, positive blood culture, increased number of lumbar cerebrospinal fluid cells, complete or incomplete obstruction of the spinal canal, increased protein, decreased sugar and chloride, Spinal cord iodine angiography or spinal MRI can confirm the exact location of the abscess.
Examine
Examination of acute suppurative myelitis
1. The peripheral blood leukocyte count (WBC) count is significantly increased in the acute phase, mainly neutrophils, and immature cells may appear.
2. Cerebrospinal fluid (CSF) appearance is turbid, pus-like, white blood cell count is 1000 ~ 10000 / mm3, a few cases are higher, mainly neutrophils, can account for more than 90% of the total number of white blood cells, and sometimes pus cell accumulation is a block At this time, the smear and pathogenic bacteria culture were mostly positive, and occasionally the first lumbar puncture was normal. After a few hours, the examination turned into purulent, the protein increased, reaching 1.0g/L or more, and the sugar content was reduced, which was low. Below 0.5 mol/L, the chloride content also decreases.
3. Determination of bacterial antigen
Commonly used methods are polymerase chain reaction (PCR), convective immunoelectrophoresis (CIE), latex agglutination test (LPA), enzyme-linked immunosorbent assay (ELISA), radioimmunoassay (RIA) and the like.
4. Other selective inspection items
Including: blood routine, blood electrolytes, blood sugar, urea nitrogen, urine routine.
5. X-ray film inspection
Chest radiographs are particularly important in patients with acute suppurative myelitis, and local abscesses can be found.
6. Spinal cord iodine angiography or spinal MRI.
Diagnosis
Diagnosis and diagnosis of acute suppurative myelitis
The diagnosis points of this disease: onset after systemic or local suppurative infection, high fever, paraplegia, dysfunction of urine and urine, positive blood culture.
It should be differentiated from acute epidural abscess, which usually forms 3 to 4 weeks after acute bacterial infection, with obvious and severe radiculopathy, tenderness of the spine, and positive Lumbar puncture.
