acute transverse myelitis in children
Introduction
Introduction to acute transverse myelitis in children Acute transverse myelitis (ATM) refers to acute transverse spinal cord involvement, also known as acute myelitis (AM). The clinical features are limb paralysis, loss of conduction tract sensation and bladder rectal dysfunction. . basic knowledge Sickness ratio: 0.0001% Susceptible people: children Mode of infection: non-infectious Complications:
Cause
Causes of acute transverse myelitis in children
(1) Causes of the disease
The disease often has viral infections as prodromal symptoms such as measles, chickenpox, herpes, rubella, mumps, EB virus infection, influenza virus, echovirus and other viral infections involving the respiratory or digestive tract, human immunodeficiency virus (HIV). It can also be accompanied by myelitis.
(two) pathogenesis
The gray matter and white matter of the spinal cord have necrotizing lesions, congestion, edema, cell infiltration, nerve cells, axons, and myelin sheaths. The affected parts are more common in the thoracolumbar segment of the spinal cord, and may also occur in the cervical spinal cord. The range of involvement may be limited. One segment or several segments, the pathogenesis is not completely clear, because the disease has seasonal (winter), cluster, there may be a history of pre-infection, cerebrospinal fluid may have leukocytosis, and its pathological changes are inflammatory Myelin is the main cause, and it is considered that this disease is an autoimmune disease after infection.
Prevention
Prevention of acute transverse myelitis in children
Actively prevent and cure various infectious diseases, actively prevent viral infections in the respiratory tract and digestive tract, especially viral infectious diseases, and do a good job in vaccination.
Complication
Complications of acute transverse myelitis in children Complications
Progressive paraplegia can occur, or it can involve or be accompanied by ascending quadriplegia and infection.
Symptom
Acute transverse arteritis symptoms in children Common symptoms Powerless sensory disturbances Paraplegia reflexes disappeared Quadriplegia, diarrhea, back pain, reflexes, abdominal pain
Symptoms are mostly numbness of the lower extremities, banding or root pain of the lesions, and then develop into complete transverse damage of the spinal cord, the chest bone is most often involved. Exercise, sensation, and autonomic dysfunction below the lesion level.
(1) dyskinesia
Early common spinal shock, showing paraplegia, limb and tension and sputum reflex disappeared, no pathological signs. The shock period is mostly 2-4 weeks or longer, and the spinal cord injury is severe, and the complications of pulmonary and urinary tract infections and acne are longer. During the recovery period, the muscle tension gradually increased, the sputum reflex was hyperthyroidism, pathological signs appeared, and the limb muscle strength gradually recovered from the distal end.
(2) Sensory disorder
All the sensations below the lesion segment are missing. At the upper level of the sensory disappearance level, there may be a hypersensitivity zone or a band-like sensory abnormality. The sensory plane gradually decreases with the recovery of the disease, but the recovery of the motor function is slower.
(3) autonomic dysfunction
Early urinary turbulence, no bladder filling, a tension-free neurogenic bladder, excessive bladder filling filling urinary incontinence; with the recovery of spinal cord function, bladder capacity shrinks, urine filling to 300-400ml spontaneous urination, It is called a reflexive neurogenic bladder. No sweat or sweat, skin desquamation and edema, loose stents and hyperkeratosis below the lesion plane.
Examine
Examination of acute transverse myelitis in children
The appearance of cerebrospinal fluid is colorless and transparent, lymphocyte and protein content can be slightly increased, chloride and sugar are normal, and virus-specific IgM antibody, OB antibody and IgG index are examined.
Routine examination of vision, fundus and visual evoked potentials, and early spinal MRI examination, can help distinguish the nature and extent of spinal cord lesions.
Diagnosis
Diagnosis and diagnosis of acute transverse myelitis in children
diagnosis
According to the acute onset, typical paraplegia, sensory disorder plane and urinary retention, it is not difficult to diagnose acute myelitis, but it is still necessary to do spinal MRI as soon as possible, except for spinal cord tumors, abscesses, vascular malformations.
Differential diagnosis
1. When identifying polio with polio, there is often a spinal shock period, which is characterized by acute flaccid paralysis. First, it needs to be differentiated from polio, except for stool virus.
2. Identification with GBS should also be differentiated from GBS, especially in infants and young children GBS check the sensory disorder plane is difficult to be accurate, but GBS has no urinary dysfunction, and the pyramidal tract sign negative is the key point to distinguish with ATM.
3. Optic neuromyelitis When the myelitis is diagnosed, it should be further differentiated from optic neuritis. Generally speaking, although optic neuromyelitis can occur at the same time or after several days after spinal symptoms, it is difficult to predict whether optic nerve symptoms are first detected. For optic neuromyelitis, attention should be paid to follow-up.
4. Different from multiple sclerosis (MS), the disease may have multiple recurrences, which need to be differentiated from multiple sclerosis (MS). MS is a central nervous system autoimmune disease with various clinical manifestations, and the course of disease is relieved and relapsed. ATM and MS The main points of identification are: brain MRI results are normal, OB negative in cerebrospinal fluid, and central nervous system electrophysiology (VEP and ABR) results outside the spinal cord are normal, so MS is not considered, and recurrent ATM is diagnosed.
