myelitis
Introduction
Introduction to myelitis Myelitis refers to a disease caused by an infection or toxin that invades the spinal cord. Because the lesions in the spinal cord are often transverse, it is also called transverse myelitis. Acute myelitis caused by viral infection occurs mostly in young and middle-aged, no gender differences, scattered onset, and onset is more urgent. There are many mild prodromal symptoms such as low fever, general malaise or symptoms of upper respiratory tract infection. Most of myelitis is an autoimmune reaction caused by viral infection. The main pathogens are influenza virus, herpes zoster virus, rabies virus, poliovirus, etc. In recent years, there have been reports of myelitis caused by hepatitis virus. A few days before the disease or 1 to 2 weeks, there is often a history of upper respiratory tract or intestinal infection, vaccination history, or cold, overworked, weight-bearing, sprain and other incentives. The disease has a rapid onset. Complete paraplegia can occur within hours to 1-2 days. Some patients have pre-existing symptoms such as back pain, belt sensation, limb numbness, weakness, etc. before the onset, and gradually develop to full sputum after several days to ten days. basic knowledge The proportion of illness: 0.052% Susceptible people: no special people Mode of infection: non-infectious Complications: Acne Constipation
Cause
Cause of myelitis
Virus infection (45%)
Most of myelitis is an autoimmune reaction caused by viral infection. The main pathogens are influenza virus, herpes zoster virus, rabies virus, poliovirus, etc. In recent years, there have been reports of myelitis caused by hepatitis virus.
Other factors (20%)
Excessive or excessive exposure to chemical poisons, causing structural damage and metabolic damage, and causing disease and poisoning; or when you eat, touch or inhale a substance, the body may be overreacted and allergic, etc. Can cause inflammation of the spinal cord.
Secondary (15%)
Some of the patients are still unexplained, but there are often symptoms of upper respiratory tract infection before the disease.
Prevention
Myelitis prevention
1, pay attention to keep warm, avoid cold, strengthen physical exercise, enhance physical fitness, prevent upper respiratory tract infection, is of great significance for the prevention of this disease.
2, keep the skin clean and dry, keep the sheets dry, soft, flat, turn over, keep your limbs in a functional position, do passive exercise as early as possible, cushion with a balloon or cushion in the sputum, sputum, shoulder blades, etc., and massage regularly. Then use safflower alcohol to lick.
3, keep the airway unobstructed, and clear the secretions of the respiratory tract in time. For those who have difficulty breathing, take oxygen as soon as possible, coughing is weak and can not discharge sputum, timely tracheotomy, if necessary, use a respirator. For patients who have used a respirator, the suction should be timely, no more than 15 seconds / time, between 3 to 5 minutes between the two, the wet tube should be dripped into the trachea, 2 ~ 5ml / time, every 15 1 minute, the inner casing is replaced 2 times/day, the outer casing is replaced once every half month, and the gauze pad is replaced 2 times/day.
Complication
Myelitis complications Complications, acne constipation
Common complications of myelitis include urinary tract infections, acne, and constipation.
Symptom
Symptoms of myelitis common symptoms limb weakness, low back pain, dysuria, muscle atrophy, unclear, difficulty breathing, quadriplegia, upper abdomen, and lower back... limb numbness, difficulty swallowing
symptom
A few days before the disease or 1 to 2 weeks, there is often a history of upper respiratory tract or intestinal infection, vaccination history, or cold, overworked, weight-bearing, sprain and other incentives. The disease has a rapid onset. Complete paraplegia can occur within hours to 1-2 days. Some patients have pre-existing symptoms such as back pain, belt sensation, limb numbness, weakness, etc. before the onset, and gradually develop to full sputum after several days to ten days.
The clinical symptoms of myelitis may vary depending on the location and extent of the lesion. Because the thoracic segment is longer and the blood supply is poor in some segments, the lesion often affects the thoracic cord. The first symptom is often numbness and weakness in the lower extremities, back pain in the corresponding parts of the lesion, banding, or difficulty in urinating. After 2 to 3 days, the disease progressed to a peak, and there was a complete paralysis below the level of the lesion. The feeling disappeared, with little or no sweat and two stools.
Early onset, in the stage of spinal cord shock, limb flaccid paralysis, also known as soft palate. After 2 to 4 weeks, the limbs gradually become sputum, which is called sore sputum. The problem of urination is also changed from urinary retention to urinary incontinence. When the lesion involves the cervical spinal cord, quadriplegia can occur. If you have a high neck (C4 or higher), you may have difficulty breathing. Cervical encephalomyelitis can have soft upper limbs and lower limbs. When the lesion is in the lumbar spinal cord, the lower extremity is flaccid paralysis, and muscle atrophy can be seen in the early stage. When the lesion is in the iliac pulp, the sphincter disorder is obvious, and there is no obvious sputum. In addition, there is a kind of ascending myelitis. The onset of this type of myelitis is rapid, and the lesion can develop rapidly from the bottom to the top, often reaching a peak within 1 to 2 days, even within a few hours. Quadriplegia, difficulty swallowing, unclear speech, difficulty breathing, and even respiratory muscle paralysis and death.
Sign
Transverse spinal cord lesions below the lesion level can be seen. Complete motor paralysis occurs, deep and shallow sensation disappears, less sweat or no sweat and sphincter dysfunction. During the shock period, the limbs were flaccid paralysis, the muscle tension was low, the tendon reflexes were low or disappeared, the pathological signs were negative, the abdominal wall reflex and the cremaster reflex disappeared; the muscle tension during the recovery period was increased, the sputum reflex was hyperthyroidism, and the pathological signs were positive.
Examine
Examination of myelitis
There are many clinical symptoms of myelitis, mainly due to loss of sensation, disturbance of rectal function and limb paralysis. In this case, timely treatment is needed. What tests can be used to diagnose myelitis?
1. Lumbar puncture: The neck test is smooth, and 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 cell number and protein content are normal or slightly increased, lymphocytes are dominant, and sugar and chloride are normal.
2. Imaging examination: the spine X-ray is normal. MRI typically shows thickening of the spinal cord in the lesion, and multiple lesions or spotted lesions in the intramedullary segment of the lesion, showing T1 low signal, high T2 signal, uneven intensity, and fusion. Some cases can always be abnormal.
1. Spinal MRI: visible spinal cord swelling, mostly uneven long T1, long T2 signal.
2. Spinal cord CT: often combined with myelography. It can be seen that the spinal cord is slightly thickened and the density is uneven.
3. Myelography: how to check for myelitis? Common diffuse swelling of the spinal cord, or can be normal. It is mainly used for cases with atypical clinical manifestations and is differentiated from other diseases. Acute examination can cause aggravation of the condition.
3. 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.
4, blood picture:
(1) blood routine: white blood cells can be increased in acute attacks, mainly polymorphonuclear leukocytes.
(2) ESR: The acute attack period can be accelerated.
(3) Immunological indicators: In acute attacks, the ratio of Th/TS (helper T cells/inhibitory T cells) in peripheral blood increased, total complement levels increased, and immunoglobulin increased. As the disease eases, it tends to decline.
Diagnosis
Diagnosis and differentiation of myelitis
Western medicine diagnosis
Signs:
1. Movement disorders: mainly manifested as upper motor neuron paralysis below the lesion segment. However, in acute onset, early can be a transient flaccid paralysis called spinal cord shock. After several days to several weeks, typical signs such as hyperreflexia, increased muscle tone and pathological reflex appear. The corresponding muscles of the diseased segment showed lower motor neuron paralysis, but most of them had no typical signs. Most of the movement disorders are symmetrical, but they can also involve one side, or the degree of disease on both sides is different. If the lesion is high, respiratory muscle paralysis, difficulty swallowing, etc. may occur.
2. Sensory disturbance: the feeling is reduced or lost below the lesion segment. The depth and sensation are affected to varying degrees, but the bilateral severity is not necessarily symmetrical. If only one side of the spinal cord is involved, it is manifested as a contralateral limb pain, a loss of temperature, and a deep sensory loss on the same side. There is often a hyperalgesia zone in the junction zone where the sense of normality and sensation is absent.
3. Autonomic symptoms: urinary retention or constipation in the acute phase, urinary incontinence gradually occurs after the spinal shock period, and some cases eventually become autonomic bladder. Other autonomic dysfunctions, such as Horner syndrome, vasomotor abnormalities, sweat secretion and nutritional disorders, and visceral dysfunction, may occur depending on the segment of the lesion.
Laboratory diagnosis
Blood: Peripheral blood white blood cell counts are normal or slightly elevated. Cerebrospinal fluid: Cerebrospinal fluid pressure is not high. White blood cells can be seen in the cerebrospinal fluid. The protein content is normal or slightly elevated. The sugar and chloride content is normal. Generally no spinal canal obstruction. In some cases, partial obstruction of the spinal cord may occur due to obvious edema in the lesion.
Image diagnosis
1. Myelography: diffuse swelling of the common spinal cord, or can be normal. It is mainly used for cases with atypical clinical manifestations and is differentiated from other diseases. Acute examination can cause aggravation of the condition.
2. Spinal cord CT: often combined with myelography. It can be seen that the spinal cord is slightly thickened and the density is uneven.
3. Spinal MRI: visible spinal cord swelling, mostly uneven long T1, long T2 signal.
Blood: There are no abnormal changes. In the acute phase and in the infected patients, the white blood cell count is increased and the proportion of neutrophils is increased. The pressure is mostly normal, and if the spinal cord swelling is significantly caused by incomplete obstruction, the pressure is reduced. Protein quantification is often mildly elevated and gamma globulin is increased. The number of cells is slightly increased or normal, and the classification is mainly monocyte. The above changes are more common in the acute phase.
Differential diagnosis
1. Spinal cord tumor: can compress the spinal cord, causing motor dysfunction, and severe spinal cord transection syndrome. However, in most cases, the disease progresses slowly, the spinal cord shock is not obvious, and the cerebrospinal fluid protein is often elevated, and the medullary cavity obstruction is easy to see. Examinations such as myelography and CT can be made clear.
2. Intraspinal extramedullary space-occupying lesions: Local hematoma, tumor, abscess, etc. can compress the spinal cord and cause clinical manifestations similar to myelitis. However, the root pain is more obvious, and the spine is abnormally curved. The symptoms and signs are obviously asymmetrical, or may be accompanied by the manifestations of the primary disease, such as the high fever of the epidural abscess. Imaging studies can confirm the diagnosis.
3. Guillain-Barré syndrome: dyskinesia and spinal cord inflammation are similar in the acute phase of spinal cord shock. However, the sensory disturbance is relatively light and short-lived, and the urinary retention is not obvious, and there is often no pain-sensing zone. The number of cerebrospinal fluid cells is normal. Protein cell separation occurred after 1 to 2 weeks.
4. In some cases, myelitis is the first manifestation of multiple sclerosis. Therefore, it is necessary to pay attention to the comprehensive examination of patients with myelitis, especially the fundus and brain signs. Intracranial imaging studies are performed as necessary.
TCM diagnosis
Dialectical:
The disease is characterized by paralysis of the limbs, numbness, and dysuria. The clinical indications should first be clear and false. Generally, the initial stage is mostly evidence. It can be seen that fever, sore throat, etc., followed by weakness or weakness of the limbs, or numbness of the skin, or urinary dysfunction. . Most of the later stages are deficiency syndrome, showing that the limbs are not used, muscles are atrophy, the skin is dry, numb, enuresis and other symptoms. Clinically, it is generally divided into the following types of syndromes.
Evil
Main card: fever, headache, sore throat, sudden weakness in the body after heat, skin numbness, or see the disease from the bottom up, quadriplegia, even tongue muscle weakness, cough, difficulty swallowing, short urination, constipation Knot, red tongue, thin yellow fur, floating pulse.
Analysis: This card is caused by warm sinister poison and infringement of lung health. Hot stagnation of the lungs, so see fever, sore throat. The main air of the lungs is toward the hundreds of veins, the evil heat hurts the lungs, the lungs are hot and painful, and the skin is dehydrated, so the skin is insensitive. The tendons are dying, so the limbs are weak and paralyzed. The lungs are closed and the liquid is sputum, which is blocked by the airway. Therefore, it is difficult to see cough and swallow.
2. Wet heat
Main card: body heat, lazy words, chest full, weak limbs, skin numbness, or tingling, itching, urinary unfavorable, even shackles, constipation, red tongue, yellow coating , the number of slips.
Analysis: This card is caused by exogenous warm sinister poison and evil spleen and stomach. The spleen loses health and transports, wet and turbid endogenous, and damp heat and resistance, so it looks like the body is not hot and the chest is full. The dampness and heat, the qi and blood are not smooth, the collaterals are blocked, so the limbs are weak and weak. Qi and blood can not be warm, so see skin numbness or itching or stinging. The bladder is wet and hot, and the gasification is unfavorable. Therefore, it is unfavorable to see the urination or the sputum is closed.
3. Qi deficiency and blood stasis
Main card: limbs are paralyzed, soft and not used, pale complexion, Shenpi fatigue, enuresis or urinary dysfunction, pale tongue, thin white fur, fine veins.
Analysis: This card is a virtual one, and it is seen in those with a long course of disease. The disease is damaged for a long time, the qi deficiency can not transport blood, the blood is not smooth, the phlegm is blocked, the tendons are dying, and the limbs are not used. Disease and bladder, gasification lost, so see enuresis or urinary dysfunction.
4. Liver and kidney yin deficiency
Main card: limb paralysis, muscle atrophy, flexion and restraint, dry skin, numbness, or enuresis, with dizziness, tinnitus, hot flashes, night sweats, red tongue, less moss, pulse breakdown.
Analysis: This card is seen in the course of the disease, liver and kidney deficiency. The disease is unhealed for a long time, the liver and kidney are damaged, the liver and kidney are not enough, and the bones and muscles are lost. Therefore, the limbs are paralyzed and the muscles are atrophied. The meridians are unfavorable, so they see limbs flexing and restraining. Yin Huowang, so see hot flashes, night sweats, upset and thirst embolism.
