Myelitis - Causes, Symptoms and Treatment .MF .
Myelitis - is an infectious spinal cord lesion.
myelitis myelitis is divided into primary and secondary.The primary disease are caused by various neurotropic viruses (Coxsackie, ECHO, rabies and others.).Secondary myelitis occur in a number of common infections - tifah, brucellosis, measles, syphilis.Infectious agents entering the spinal cord hematogenous or by contact, causes a local inflammatory process, accompanied by blood circulation and the development of perifocal edema.
If signs of traumatic myelitis, vascular and toxic lesions of the spinal cord to speak about mieliticheskom syndrome.
Symptoms of the disease can precede brief prodrome with general malaise, weakness, muscle and joint pains.Usually before the defeat of the spinal cord marked rise in body temperature, appearance radikulonevriticheskogo pain, intermittent urination difficulties.Pretty typical as paresthesias in extremities.spinal injury syndrome may occur acutely insultoobrazno or grow slowly for 1 - 3 days.
myelitis Clinical presentation depends on the severity of the process, as well as on the location and extent of the lesion focus both across, and in the spinal cord dlinniku.And in the first 2-3 weeks of the disease with swelling and compression of the spinal cord there is a complete picture of the cross defeats and only later revealed the true dimensions of the process.The most frequent myelitis with foci in the thoracic spinal cord segments.
Symptoms consist of segmental myelitis and conductive disorders.Paresis and paralysis are peripheral or central origin (with muscular hypertension spastic type, high tendon reflexes, extension reflex zones, clonus stop).Extensor pathological reflexes on the feet (. Babinski, Oppenheim, Schaeffer and others) appear in the first days of the disease, and flexion (Rossolimo reflex) - after 10-14 days.Typically, particularly when the centers located in the cervical and thoracic spinal segments, protective reflexes clearly expressed on the basis of which subsequently formed contracture.Irregularities in sensitivity of transverse myelitis have conductor character, and all kinds of sensitivity drop.The upper limit of sensitivity disorders is 1-2 segments below the upper limit of the spinal fire.The sensitivity of skin disorders disappear zone reflexes.In the early days of the disease is usually marked delay urination and defecation.Only with lumbosacral localization mieliticheskogo outbreak occurs peripheral paresis of sphincters with a true urinary and fecal incontinence.In the case of preservation of the bladder neck elasticity appears paradoxical urination.In the future, when the central disorders of urination and defecation are performed automatically.The accumulation in the bladder residual urine creates a constant threat uroseptic complications.In transverse myelitis more or less pronounced trophic disorders as bedsores, are secondarily infected and may cause sepsis and toxic.If
inflammatory focus does not capture the entire diameter of the spinal cord, the spinal symptoms are much less.If it affects half of the developing spinal cord Brown-Sequard syndrome with paresis and disturbance of deep and partly tactile sensation on the side of the hearth, and loss of pain and temperature sensation on the opposite side.If there are multiple foci diagnosed disseminated myelitis, in combination with cerebral spinal pathology - encephalomyelitis, while lesions of the spinal cord and spinal roots and nerves - mielopoliradikulonevrit.In the latter case, the symptoms of spinal lesions are detected only in descending order poliradikulonevriticheskogo component.
During myelitis identify several periods.Acute myelitis period characterized by an increase of symptoms and lasts from a few days to 2-3 weeks.Early recovery period starts with the symptoms stabilize.Its duration is usually 5-6 months.At this time there is regression of neurological disorders, sometimes very intense.Favorable prognostic factors in this period are closing bedsores and restoration of pelvic organs.This is followed by a late recovery period and the period of residual effects.
Infectious myelitis should be distinguished from relapsing encephalomyelitis and multiple sclerosis.For the latter, characterized by not only the symptoms of spinal injury, but also the symptoms of brain damage, and often the optic nerves, quick recovery and relapsing course.
Differential diagnosis of myelitis and spinal cord tumors is based on the slow increase of symptoms in tumors, the sequence of occurrence of syndromes, the presence of pain and total or partial block of the spinal subarachnoid space, detectable during liquorodynamic samples.
Pathoanatomical picture myelitis: spinal cord lesions macroscopically flabby areas and have a grayish color;characteristic transverse spinal cord image is blurred;inflammatory center can take his whole width;multiple foci, located on different levels, are usually small in size.Microscopically observed vascular disorders, inflammatory infiltration, degeneration of neurons, fragmented disintegration of nerve fibers and their sheaths below the lesion, which may spread into several segments.Subsequently, cysts and scars are formed in place of the lost nerve tissue.
Treatment of Acute myelitis
develop transverse myelitis with marked compression syndrome and the presence of spinal block requires solving the problem of surgical intervention for the purpose of decompression.Surgical treatment is also indicated for purulent epidurit and other septic foci in the vicinity of the spinal cord.
Among the methods of conservative treatment in acute period applied antibacterial therapy.It is particularly indicated for suspected bacterial etiology or septic complications.Duration of treatment an average of 12-14 days.Showing steroids - prednisone (deksazon, dexamethasone).Dose reduction starts with a 10-12-day, the total duration of treatment 4-6 weeks.Some patients on a maintenance dose indications (about 5 mg) should leave for 2-3 months or more.Provide hormones in combination with potassium therapy.It is intended to give preference to potassium orotate having anabolic effect.From the dehydrating agents used glycerol.It is advisable to use cinnarizine, trental, ksantinola nicotinate, large doses of ascorbic acid, B vitamins
In the absence of self-urination carried out 2 times a day, bladder catheterization.At the same time use antiseptics - nitrofuran derivatives: furagin, furadonin, furazolidone.Featured products alternated with each other, as well as 5-NOC (nitroksolin).Each of the drugs given for 7-10 days.
are very important good nutrition, proper care (comfortable position, the application of the slip circle, the use of the suspensions, the skin daily with warm water wash with soap and water and rubbing it with camphor or a simple alcohol, cologne).It is necessary to remove necrotic mass with pressure sores, wash them with a weak solution of potassium permanganate or hydrogen peroxide.To eliminate necrotic tissue using sterile wipes with a solution himopsina or trypsin, which is applied to the sores for several hours.With abundant purulent used tampons with hypertonic (5-10%) sodium chloride, on the treated surface of the bandage with ointment Vishnevsky, sea buckthorn oil, balms.To improve the granulation and epithelialization bedsores can irrigate juice fresh tomato, insulin and other stimulants.Excessive granulation sear silver nitrate solution.
move to restorative treatment for the stabilization process.It is necessary to appoint a massage, physical therapy, heat treatments, electrophoresis of nicotinic acid on the area of the spinal hearth;spend orthopedic activities.During this period, shows anticholinesterase medications (galantamine, oksazil et al.), Stimulants (Dibazolum), B vitamins, nootropics, amino acids (methionine, cerebrolysin).In severe spasticity used Mydocalmum.Spa treatment (mud resorts) can be administered in 5-6 months after the onset of the disease.
neurologist Tatiana Novikova