spinal cord abscess
Introduction
Introduction to intraspinal abscess Intraspinal abscess is a rare lacunar and suppurative central nervous system infection. Its cause is similar to brain abscess. Infectious exudation leads to inflammation of the enzyme-producing multinucleated cells, causing liquefaction necrosis, necrotic tissue by fibroblasts. Surrounded by the resulting capsule. Early diagnosis of intraspinal abscess is difficult, and the rate of disability is high, which should be noted. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: urinary retention
Cause
Cause of intraspinal abscess
Blood-borne dissemination of distant infections
About 50% of the total reported cases can enter the spinal cord through arteries or veins. It is clinically common in the lungs, heart (subacute endocarditis), genitourinary system, induced abortion and skin purulent Infection, etc., abscess can occur in any spinal segment, but the dorsal side of the thoracic spinal cord.
Spread of adjacent infections
The anatomical upper subarachnoid space of the spinal cord communicates with the lymphatic vessels of the mediastinum, abdominal cavity, and retroperitoneal space through the spinal nerve. Therefore, the infection can enter the spinal cord via lymphatic vessels, with or without meningitis. Half of the patients are from lumbosacral infection and tail. In the case of sinus infection, most of the abscesses occur in the spinal cord adjacent to the primary infection.
infection
1. Post-traumatic infections are more common with open spinal cord injury, lumbar puncture and so on.
2. Hidden infection refers to the unknown source of infection.
3. Other sources have reported at least 2 intraspinal abscesses due to HIV infection in patients.
Pathogenesis
The pathological changes of intraspinal abscess vary with the size of the abscess and the length of the disease. Small abscesses often occur frequently and can be seen with the help of a microscope. Most of them are single-shot, which can involve several spinal segments, occasionally affecting most spinal cords, acute phase. Miliary abscess is a small nodule composed of mononuclear, lymphocytes and pleomorphic cells and epithelial cells. It spreads along small blood vessels. Bacteria can be found in small nodules and small blood vessels. Hemorrhage often occurs near small nodules. It can be fused into a larger abscess or cause suppurative myelitis with central softening and necrosis of the spinal cord, the abscess capsule in the chronic phase, the inner layer consists of reticular collagen fibers and multinucleated cells, and the middle layer consists of new capillaries, fibroblasts, and histiocytes. And the plasma cells, the outer layer is composed of connective tissue. The abscess in the spinal cord is located in the central part of the parenchyma of the spinal cord and extends along the long axis of the spinal cord. The longitudinal conductive fibers are separated and occupy the voids, which are cylindrical and do not damage the fiber conduction bundle. Also unlike epidural abscesses, extensive venous infarction rarely occurs.
Prevention
Prevention of intraspinal abscess
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.
3, to prevent infection, infection caused by myelitis, can be primary, or secondary. The most common are the primary, the pathogens are mostly viruses, caused by purulent bacteria. Secondary episodes occur during the course of acute infectious diseases such as measles, scarlet fever, diphtheria influenza, erysipelas, chickenpox, pneumonia, endocarditis, gonorrhea, and whooping cough, or chronic infectious diseases of the urinary system, and after vaccination.
4. To prevent toxins, including exogenous toxins or endogenous toxins. More common exogenous toxins that cause myelitis such as carbon monoxide, carbon disulfide poisoning, anesthetics and subarachnoid injections.
5, diet: mainly light, eat less spicy things, less food, thick taste.
6, living: regular living, avoid excessive sexual life, clothing should not be too tight, to avoid cold.
Complication
Intraspinal abscess complications Complications, urinary retention
It varies depending on the location, size, single or multiple appearance of the abscess, and the length of the disease. Although some patients complain of back pain, neck pain or hand pain, most of them only show progressive aggravation of spinal cord dysfunction, such as long beam sign, urinary retention, muscle weakness below the affected spinal plane, and different types of sensory loss. Depending on how fast the disease progresses, sputum reflexes can be attenuated or increased, and Babinski signs can be present or absent. Many patients may never get fever even in those with acute illness.
Diagnosis can generally be made based on medical history, clinical manifestations, and results of ancillary examinations.
Symptom
Intraspinal abscess symptoms Common symptoms Abscess back pain Spinal cord infiltration and inflammation
Because of the location, size, single or multiple of the abscess, and the length of the disease, although some patients complain of back pain, neck pain or hand pain, most of them only show progressive aggravation of spinal cord dysfunction, such as long beam sign. Urinary retention, muscle weakness below the plane of the spinal cord and different types of sensory loss. According to the speed of disease progression, sputum reflex can be weakened or increased. Babinski sign may or may not exist. Many patients may be affected by acute cases. Never fever.
Examine
Examination of intraspinal abscess
Peripheral white blood cell count may be elevated, but sometimes very mild, cerebrospinal fluid white blood cell count and protein are elevated, cerebrospinal fluid culture is almost always negative.
The plain film is generally negative, but if the plain film shows discitis, myelitis or paravertebral infection, it must be suspected that the infection will spread to the spinal cord.
In the past, myelography often saw spinal cord widening consistent with intramedullary lesions, often with complete obstruction of the spinal canal. Recently, MRI has replaced myelography as the first choice. MRI shows thickening of the spinal cord with edema. The T2-weighted image is Intramedullary high-signal, T1-weighted images are lesions with equal or low signal in the intramedullary, and enhanced intramedullary lesions after T1 weighting.
Diagnosis
Diagnosis and differentiation of intraspinal abscess
Diagnosis can generally be made based on medical history, clinical manifestations, and results of adjuvant examinations.
It needs to be differentiated from epidural abscess, acute transverse myelitis, vertebral osteomyelitis, epidural hematoma and intraspinal tumor. It can be identified according to their clinical features and imaging examination.
