Transverse myelitis - types, symptoms, methods of treatment. Acute myelitis Radiation myelitis treatment

“Keep your back straight,” our parents and teachers taught us from childhood. But the health of the spine is not only in how we hold it, but also in what condition it is in. You can keep your back straight, but at the same time feel unbearable pain, because..

What is it - myelitis?

The nervous system consists of two main parts - the central and spinal cord. What is myelitis? This word is called an inflammatory neurological disease in which the gray and white matter of the spinal cord is affected.

Classification:

Flow form:

Spicy;
Subacute;
Chronic.

By prevalence:
- Limited - a clearly defined focus;
- Diffuse (common, disseminated) - inflammation covers the entire spinal cord;
- Multifocal - inflammation is limited, but in many places throughout the spine;
- Cross - coverage of several segments in a row.
By pathogens are divided into types:
- Bacterial (infectious);
- Viral;
- Traumatic;
- post-vaccination;
- Toxic (intoxication);
- Compression;
- Ray;
- Idiopathic (often called autoimmune, neuroallergic) - the cause cannot be determined.
According to the mechanism of occurrence:
- Primary - develops as an independent disease;
- Secondary - develops as a result of another pathology.
According to the focus of inflammation:
- Cervical;
- Thoracic;
- Lumbar.

Causes of myelitis of the spinal cord

The causes of myelitis of the spinal cord are divided by type of pathogen:

The bacterial form develops against the background of infection in the spinal cord. This can happen both with a back injury and with the development of an infectious pathology in another organ of the body. A common cause of this form is purulent meningitis, from which meningococcal infection penetrates the spinal cord. Other provocateurs can be pale treponema (with syphilis), bacteria that cause typhus, measles, brucellosis.
The viral form manifests itself in 40% of cases and occurs against the background of damage to the substances of the spinal cord by Coxsackie group viruses, rabies virus, influenza bacteria, etc.
The traumatic form occurs against the background of penetrating, open or closed wounds of the spine, when the infection joins and penetrates inside. Here the disease develops as an independent.
Toxic develops as a result of poisoning the body with lead, mercury, and other chemicals. It can be observed with the abuse of drugs, contaminated food, alcohol. Often occurs in workers in hazardous industries.
Post-vaccination manifests itself as a result of an allergic reaction when a patient is given a vaccine, and the body has a predisposition to reject it.
The radiation form occurs after the patient undergoes radiation therapy for any malignant tumors and metastases of nearby organs.
The idiopathic transverse form develops for unknown reasons. It is assumed that this is the result of the body's attack on itself, due to which the disease develops. It can develop against the background of multiple sclerosis, Devic optomyelitis.

Without concomitant factors, the disease may not develop. What are these factors?

Hypothermia or overheating of the body;
Weak immunity;
Stress and overwork;
Infectious diseases of other systems.

Symptoms and signs

Symptoms and signs of inflammation of the spinal cord are divided into stages and forms of the course. However, it all starts with the prodromal period, which is inherent in many infectious diseases (for example, laryngitis, sinusitis, adenitis, etc.):

Weakness;
Pain in muscles and joints;
Malaise;
Sweating:
Temperature increase.

Against the background of these symptoms, other signs develop, which depend on the type of myelitis.

In acute focal form, signs are distinguished:

Pain in the back and chest, which is inherent in all types of acute forms;
Violation of the sensitivity of the lower extremities, which manifests itself in crawling, numbness, tingling;
Numbness intensifies and turns into paralysis of the legs;
Defecation and urination are disturbed: delay and their complete non-excretion.

The acute common form manifests itself in the following symptoms:

Asymmetric sensitivity and mobility on the right and left;
Urination and defecation slightly disturbed.

Subacute and chronic forms are expressed in such signs:

Back pain is the main symptom of all types of subacute and chronic myelitis;
Violation of sensitivity;
Paralysis of the legs, which is at first flaccid and then becomes pathological;
Violation in the work of urination and defecation;
The formation of bedsores due to impaired blood circulation and blood supply, tissue nutrition;
Blood poisoning can occur against the background of stagnation of urine and bedsores, which are favorable conditions for the penetration and reproduction of infection.

The radiation form may appear after 2 years after irradiation in the symptoms inherent in the affected area. Most often, the lower limbs suffer, which lose their sensitivity and begin tingling, crawling.

Violation of the sensitivity of the lower extremities is a decrease in pain threshold, temperature perception and the inability to determine how the legs lie if you close your eyes. The opposite effect can be observed when the sensitivity is increased.

Myelitis manifests itself in characteristic stages:

Acute stage - an increase in the symptoms of myelitis and a duration of up to 3 weeks.
Early recovery stage - stabilization of well-being and duration up to 5 weeks. Decrease in disturbances in sensitivity and work of a small pelvis become characteristic, and also decubituses are closed.
late recovery stage.
Residual effects (recovery stage).

Myelitis in children

Myelitis in children occurs for the same reasons as in adults. An untreated inflammatory or infectious disease (especially in the brain) can move to the spinal region. Manifested in an increase in temperature, swelling of the legs and drowsiness. It is recommended to immediately contact a pediatrician for examination and treatment.

Myelitis in adults

Myelitis in adults occurs in both women and men. Women are more likely to suffer from psycho-emotional instability, which allows penetrating infections to provoke illness. Men suffer because of neglect of their own health, as well as because of work in hazardous industries.

Diagnostics

Diagnosis of myelitis of the spinal cord begins with the patient's visit to the doctor for reasons of general intoxication and the appearance of the first signs of paralysis. The doctor collects complaints and makes a general examination, which is supplemented by the following procedures:

Puncture of cerebrospinal fluid;
Analysis of cerebrospinal fluid for inflammation and infection;
Blood test;
MRI or tomography with the use of contrast;
Suboccipital myelography;
Tests for the detection of other pathogens;
Evaluation of strength in the limbs;
Electroneuromyography;
Consultation with a surgeon.

Treatment

Treatment of inflammation of the spinal cord is carried out in a stationary mode and providing rest. If folk remedies are used, then only as additional methods that soothe and reduce symptoms, but do not cure the disease.

What is the treatment for myelitis? Medicines:

Hormonal drugs: prednisolone, glucocorticoids.
Antibiotics, even if bacteria and viruses are not found in the cerebrospinal fluid. Reception is carried out in order to prevent the penetration of infection into the affected area. Antiviral drugs are also prescribed in case of damage to the spinal cord by viruses.
Diuretics: Furosemide, Mannitol, etc.
Narcotic and non-narcotic analgesics.
Antipyretics (antipyretics).
Anticholinesterase drugs to improve bowel movements.
Anti-inflammatory agents.
Vitamins.
Painkillers.
Muscle relaxants for muscle spasms.

How else is myelitis treated?

Physiotherapy procedures:

Massage of the lower extremities and those places where bedsores form;
Therapeutic exercise in bed;
Massage with tetracycline or penicillin ointment;
acupuncture;
Bladder catheterization or epicystostomy.

Although folk remedies do not cure the disease, they help at home to reduce unpleasant symptoms:

Boil potatoes, mash, add the same amount of honey, make a cake. Attach it to the neck, cover with cling film. When the cake has cooled, change it to another.
To aloe juice and dry mustard (taken in equal proportions), add a little propolis and vodka. Make a mixture that resembles plasticine. Put on the neck and cover with cling film, preferably all night.

The patient's menu should be balanced, full of vitamins and proteins.

life forecast

How long do people live with myelitis? The disease is not considered fatal, but worsens the prognosis of life due to its complications that arise. The most important complication that can occur in case of improper or no treatment is paralysis of the lower extremities (observed in 30% of cases). Also, sepsis should not be ruled out - the spread of infection to other organs through the blood.

How can myelitis develop?

Favorable option: acute myelitis passes into the stabilization stage, the symptoms gradually subside and the patient recovers.
Satisfactory option: transverse myelitis accompanies the patient throughout his life, without leading to a deterioration in health.
An unfavorable option: the spread of the infection up the spinal cord and its penetration into the brain stem.

You should resort to preventive measures that will help to heal and prevent the recurrence of inflammation of the spinal cord:

Treat infectious diseases of other organs, which often provoke other inflammatory processes in the body.
Perform physical exercises.
Monitor the health of the spine, for example, keep it straight, and also not expose it to damage.
Seek medical attention when the first symptoms appear.

Myelitis is an inflammation of the spinal cord. Myelitis can be primary or secondary. Primary myelitis is caused by neurotropic viruses. Secondary myelitis is much more common than primary and occurs with common infectious diseases: influenza, typhoid, measles, etc. The causative agents of infection and them penetrate into the lymphatic and cause more or less pronounced inflammatory and dystrophic changes in it. With viral myelitis, the membranes of the spinal cord, roots and nerve trunks are affected to varying degrees.

Myelitis, as a rule, develops acutely: the temperature rises, chills appear, general malaise, meningeal symptoms are often expressed (see). In the blood, leukocytosis, a shift of the leukocyte formula to the left, accelerated are noted. Within a few hours or 1-2 days after the onset of the disease, symptoms of spinal cord injury occur, which depend on the level of the lesion. In this case, damage to the entire diameter of the spinal cord is most often noted.

Symptoms of myelitis consist of paralysis (see Paralysis, paresis), sensory disorders, dysfunction of the pelvic organs and trophic disorders.

With the localization of the inflammatory process in the region of the upper cervical segments, spastic paralysis of four limbs and violations of all types of sensitivity are observed. When the cervical thickening of the spinal cord is affected, flaccid paralysis of the arms and spastic paralysis of the legs are noted with disorders of all types of sensitivity below the level of the lesion. In lesions at the level of the thoracic segments, there is spastic paralysis of the legs with sensory disturbances below the level of the affected segments of the spinal cord. With a lesion at the level of the lumbar thickening of the spinal cord, flaccid paralysis of the legs is noted. At the onset of the disease, urinary retention and constipation occur, which are then replaced by urinary incontinence and. Later, swelling of the legs, excessive sweating may develop. The pressure is increased, the number of cells and protein in it is increased. Neurological symptoms reach their maximum during the first days of illness and persist for several weeks or months. Regression in myelitis occurs slowly and gradually. Initially, the sensitivity and function of the pelvic organs are restored, later - movements in the limbs.

In order to improve motor functions, dibazol, vitamins of group B are prescribed. To reduce muscle in spastic paralysis, mellictin 0.02 g is used 2-3 times a day. After 2 months from the onset of the disease, it is advisable to use iontophoresis with iodine, diathermy on the area of the lesion. In some cases, orthopedic treatment is indicated.

Myelitis (myelitis; from the Greek myelos - brain) is an inflammatory disease of the spinal cord of infectious, toxic and traumatic etiology. With the development of the inflammatory process only in the gray matter of the spinal cord, we are talking about poliomyelitis (see); if the process is localized only in the white matter, then focal myelitis develops, and when the process is current in both the white and gray matter, disseminated and necrotic myelitis occurs. MS Margulis (1940) distinguishes two subtypes of myelitis: focal myelitis with symptoms of transverse lesions of the spinal cord (myelitis transversa) and disseminated myelitis in the form of scattered foci along the length of the spinal cord. He also refers optomyelitis to disseminated myelitis. Currently, myelitis is considered as an independent clinical and anatomical form. A special group is made up of those cases when symptoms of brain damage - encephalomyelitis (see) join the spinal phenomena.

Etiology. Infectious myelitis and encephalomyelitis are described after various infections, endocarditis, pyelonephritis, rheumatism, etc. Purulent processes in the body can give purulent myelitis; syphilis and tuberculosis can cause both acute and chronic myelitis. There are cases of myelitis and encephalomyelitis after various vaccinations (post-vaccination). In recent years, myelitis and encephalomyelitis have been described in toxoplasmosis. A significant number of myelitis is caused by neurotropic viruses. Toxic myelitis and encephalomyelitis can develop after acute and chronic poisoning with lead, carbon monoxide, and sometimes during pregnancy and childbirth.

Extramedullary tumors, tuberculous lesions of the spine and meninges play an important role in the development of compression myelitis. In recent years, compression myelitis has been described with lesions of the intervertebral discs, with Schmorl's hernias. Traumatic myelitis may occur with penetrating spinal injuries; with a closed spinal injury, softening foci with hemorrhages into the substance of the spinal cord were noted.

pathological anatomy. Myelitic foci, especially in acute cases of myelitis, can already be seen with the naked eye. There is a general increase in volume, hyperemia and a softer consistency of the brain. The boundaries between white and gray matter are smoothed. MS Margulis distinguishes two forms of focal myelitis according to the nature of the process: vascular-inflammatory and alterative. The main form should be considered the first, when the vascular-inflammatory reaction of the tissue with lymphoid infiltration around the vessels predominates in the process. In the area of the lesion, the vessels are dilated, there are small perivascular hemorrhages, increased reproduction of glia, especially microglia in the white matter. The essence of the pathological process in myelitis is the disintegration of nerve fibers with damage to the myelin sheath, and then the axial cylinder. Foci of demyelination occupy different areas of the white matter. Ganglion cells of the spinal cord in the foci of inflammation with symptoms of tigrolysis and atrophy. The alternative form of focal acute myelitis includes those cases when hemorrhages and infarctions of the spinal cord due to thrombosis of the vessels of the pia mater or vasocorona come to the fore.

With optomyelitis, along with changes in the spinal cord, optic neuritis with demyelination of their fibers, inflammatory changes in the brainstem, cerebellum and cerebral cortex, as well as in the protein and choroid of the eye are found. In subacute necrotizing myelitis, necrosis is described with their predominant localization in the gray matter, but with the capture of white matter as well. In syphilitic myelitis, the inflammatory process first affects the membranes and vessels of the spinal cord, and its substance is affected secondarily - hemorrhages and softening of the spinal cord tissue develop. The phenomena of demyelination are most pronounced with syphilis in the posterior columns. In tuberculous myelitis, there may be compression of the spinal cord by cheesy masses that have burst into the spinal canal or resulting from tuberculosis of the dura mater. Tuberculous tubercles may develop in the spinal cord with changes in blood vessels, cells and fibers of the white matter.

Pathogenesis. Acute myelitis occurs in some cases in the hematogenous way with a violation of the blood-brain barrier. In most cases, spinal cord injury in acute myelitis is of lymphogenous origin. Through the nerves and roots, the infection reaches the epidural space, and from here, through the lymphatic pathways of the dura mater, the virus spreads to the subarachnoid spaces and the substance of the spinal cord.

Toxic myelitis is in the nature of degenerative changes. In these cases, they often speak not of myelitis, but of myelosis (see Funicular myelosis).

Inflammation of the spinal cord, or myelitis, is a serious disease that has serious consequences for life. Only timely detection of the disease and proper treatment allows you to get rid of all the symptoms and manifestations. The inflammatory process develops rapidly. It is extremely important to exclude self-medication and immediately contact experienced doctors.

Symptoms of myelitis appear on the rise. The patient's condition worsens every second. Among the main manifestations are the following:

a sharp increase in body temperature;
severe chills, dizziness;
muscle weakness;
back pain.

In the first days of the disease, symptoms characteristic of many diseases appear, then characteristic meningeal symptoms appear, but only a doctor can identify them and draw the right conclusions.

There are many varieties of myelitis, depending on the localization of the inflammatory process, the degree of damage to the spinal membranes. Each type of disease has its own symptoms. Back pain can occur in different areas and departments. The stage of development of the disease is also of no small importance. If at the initial stage the patient has a very bad back pain, he cannot tear his head and neck from a prone position, then after a couple of days there is paralysis of the limbs, incontinence of feces and urine.

A significant increase in the patient's body temperature is an important sign. If the temperature does not go down well, you should immediately consult a doctor. No need to wait for other symptoms to appear, let specialists quickly make a correct diagnosis.

Reasons for the development of the disease

Myelitis can be primary or secondary. In the first case, the gray and white matter of the spinal cord is initially affected. In the second case, inflammation is a consequence of other ailments. Myelitis is often caused by viruses and bacteria. Cancer patients are characterized by the so-called radiation myelitis, which develops against the background of radiation therapy. It manifests itself 6-12 months after the end of the treatment of the underlying disease. Often, both patients and attending physicians are ready for such an outcome, so the treatment of the inflammatory process begins in a timely manner, the therapy gives a positive result.

Severe hypothermia is another cause of myelitis. It is impossible to "cold" the spinal cord, but under the influence of low temperatures, the body's immune response decreases, so viruses and bacteria quickly penetrate into the membranes of the spinal cord and actively multiply there.

Diagnosis of inflammation of the spinal cord

Inflammation of the spinal cord is diagnosed in a hospital setting. First, the doctor examines the patient, collects an anamnesis. General biochemical blood tests are prescribed. Elevated leukocytes, increased ESR - these are characteristic indicators in the acute period of the disease. An accurate diagnosis can only be made after a spinal cord puncture. Examination of the cerebrospinal fluid allows not only to identify inflammation, but also its pathogens. It is determined which microorganisms are present in the fluid from the spinal cord, their sensitivity to antibiotics is checked in order to select drugs that will be effective in the treatment process.

The doctor makes certain conclusions about the alleged diagnosis already during the puncture for the puncture. This procedure is specifically performed without additional anesthesia in order to assess the patient's response. If he does not feel pain and the slightest discomfort during the puncture, we can talk about myelitis.

Types of disease

The classification of myelitis is extensive. To a greater extent, doctors need this knowledge in order to correctly diagnose the inflammatory process in the spinal cord and determine the correct treatment tactics. According to the duration of the course, acute, subacute and chronic myelitis are distinguished. The degree of damage to the spinal cord matters. Inflammation can be limited, widespread, focal. Separately isolated transverse myelitis. In this case, the inflammatory process develops in several adjacent areas.

Of no small importance is the cause of the development of myelitis. Inflammation occurs under the influence of viruses, bacteria, ionizing radiation, trauma, strong toxins. In rare cases, it is not possible to establish the cause of the development of the inflammatory process. Then myelitis is more difficult to treat.

Features of treatment

Treatment of myelitis is always carried out in a hospital setting. This problem is dealt with by a neurologist. It determines the localization of inflammation, the degree of damage to the white and gray matter of the spinal cord. The inflammatory process must be stopped. At the same time, there is a struggle with the symptoms of myelitis.

Hormonal painkillers and anti-inflammatory drugs are immediately prescribed. In our country, drugs based on prednisolone are actively used. They are effective in the treatment of myelitis. These drugs enter the body in the maximum allowable doses.

A patient with myelitis must be prescribed broad-spectrum antibiotics, also in the maximum allowable doses. These drugs must be taken even if a virus has become the cause of the development of inflammation of the spinal cord. Such actions are aimed at reducing the likelihood of developing serious negative consequences of myelitis.

Be sure to take diuretics to avoid tissues. Often, in the treatment of myelitis, the patient is already paralyzed, so additional measures are taken to avoid bedsores.

When the main danger has passed, myelitis is eliminated, the stage of recovery and rehabilitation begins. If the correct diagnosis was made in a timely manner, and the doctor immediately began treatment, the patient has a good chance to return to normal life, although some manifestations of the disease will remain with him forever.

Rehabilitation of patients after treatment

Myelitis is a serious disease that affects the bone marrow. Everyone knows that this organ is responsible for human immunity, because it is here that the production of leukocytes is carried out. Although modern medical technologies make it possible to treat myelitis, it is possible to completely get rid of the consequences of inflammation of the spinal cord only in a few cases.

Restoration of all functions and systems of the body is carried out within 1-2 years after the completion of the treatment of inflammation of the spinal cord. During this period, the patient is engaged in exercise therapy, undergoes courses of reflexology. The final prognosis largely depends on the location of inflammation, the degree of tissue damage. Patients are often given a disability group, but many return to normal life and even to work.

Myelitis is a spinal pathology that mainly affects one or two segments of the organ and is of an inflammatory and infectious nature.

Myelitis - description of the disease

The causative agent or / and its toxins penetrate the spinal cord and provoke inflammation in the latter. In this case, the bodies and processes of nerve cells are affected, the membranes, nerve trunks and roots can be damaged.

In neurology, several types of spinal cord myelitis are distinguished, each of which has its own symptoms, severity of manifestations and prognosis.

So, for example, neuromyelitis optica (optocomyelitis, Devic's disease (syndrome)) is not typical for childhood, and if it develops in children, then, unlike adults, it has a non-recurrent single-phase character, and also has a favorable prognosis.

On the other hand, before mass vaccination in children, much more often than in adults, there was such a pathology as poliomyelitis, provoked by a specific virus and having a high probability of death and disability.

A significant role in the development of secondary myelitis pathology in children is played by diseases common at this age: measles, whooping cough, chickenpox and others.

Types of disease

Myelitis is an independent primary pathology when it is caused by viruses that selectively infect neurons.

If the pathology was the result of another infectious process, which is more common, it is called secondary myelitis.

According to the intensity of the development of symptoms, the form of the disease is:

chronic course;
acute;
subacute flow.

According to localization, myelitis is distinguished:

limited? focal nature of the disease;
multifocal (scattered, disseminated) - foci at different levels;
transverse - several spinal segments are covered, which are located next to each other;
widespread (diffuse) - the entire spinal cord is affected to varying degrees.

Are the spinal sections of the cervicothoracic and thoracic affected more often, less often? cervical (myelitis of the cervical region), lumbar.

Accordingly, several characteristics can be indicated in the name of the diagnosis. Thus, the term "acute transverse myelitis" corresponds to an inflammatory lesion of a number of spinal segments with an intense, bright course.

Separate form? opticomyelitis, when, in addition to the standard symptoms of pathology, visual disturbances are present and complete loss of vision can occur.

Reasons for the development of myelitis

Purulent myelitis? This is a bacterial infection, most often provoked by meningococcus.

Almost 40% of cases of the disease are caused by viral forms of the disease caused by Coxsackie, influenza, rabies and others.

Traumatic myelitis? a consequence of trauma to the spine with a subsequent complication.

The result of poisoning with chemical compounds (lead, mercury, etc.)? toxic myelitis, in which nerves, nerve roots are often also affected.

Allergic in nature post-vaccination myelitis, which develops after vaccination in the presence of a certain predisposition (including VAP (vaccine-associated polio) when using the oral form of the vaccine).

Radiation therapy for oncological diseases of the pharynx, larynx, esophagus, etc. may lead to the development radiation myelitis.

In the case when it is impossible to establish the cause of the pathology, they speak of idiopathic myelitis. It is assumed that the main factor in the development in such episodes is the failure of the immune system.

Contributing factors:

weakness of the immune system;
hypothermia.

Symptoms and signs of spinal myelitis

The myelitic process consists of conditional stages:

acute manifestations;
early recovery (lasts about six months from the moment of stabilization of the condition);
late recovery (up to two years);
residual manifestations (after two years).

The symptoms of primary myelitis vary as follows:

first, a prodromal period (two to three days) is noted with flu-like symptoms (muscle pain, general poor health, fever,);
then there are tingling, "goosebumps" in the limbs, girdle pain;
as pain decreases, signs of spinal cord injury increase (weakness in the legs, decreased sensitivity, abdominal tension, flatulence, difficulty defecation and urination);
further there is a rapid development of trophic ulcers, bedsores (practically regardless of the quality of patient care).

A similar picture can develop in a couple of minutes, but there is also a gradual increase in symptoms over a month or even longer.

The most difficult course? in lower thoracic, lumbosacral, cervical myelitis.

Signs of secondary myelitis may appear at the peak of the underlying disease or already during recovery. So, with chickenpox, deterioration due to myelitis can occur on the 3rd - 5th day, with measles - the 5th? 7th.

In a chronic primary process, myelitis can develop at any stage. Secondary myelitis has a subacute course and negative manifestations increase over weeks.

Features of manifestation for different species

Symptoms acute transverse myelitis with stroke-like development are characterized by reduced muscle tone (lethargy) for a couple of weeks. If the disease does not progress quickly, then the dysfunction of the pelvic organs occurs later.

Acute focal myelitis:

there is a slight soreness in the back and chest with a general deterioration in well-being;
sensitivity is disturbed in the legs, numbness, tingling, “goosebumps” are felt;
develop urinary and/or fecal incontinence or difficulty defecation and/or urination.

Acute widespread myelitis is characterized by:

unevenness of symptoms from different sides of the body;
minor disorders of the functions of the pelvic organs.

Chronic, as well as subacute, the form has the following features:

mild back pain in violation of general well-being;
development of pathology processes below the localization of lesions;
violation of the sensitivity and functions of the small pelvis, paralysis;
mild paralysis at the onset of the disease and their subsequent progress to a spasmodic state;
malnutrition and blood supply to tissues with the formation of bedsores;
accession of bacinfection, blood poisoning.

For radiation myelitis:

the first signs are noted after 6 - 48 months from the moment of exposure;
the symptomatic type depends on the location of the lesion;
limb functions are predominantly impaired.

Diagnostics

The presence of signs of spinal pathology on a general intoxication background.
Puncture and examination of the cerebrospinal fluid for the presence of a pathogen, inflammatory elements.
Myelography.
CT, .

Differential Diagnosis

Myelitis is differentiated from:

traumatic compression of the spinal cord;
metastatic lesions of the spine;
spinal stroke and / or arachnoiditis;
polyneuropathy;
epiduritis, etc.

Toxic polyneuritis is a disease, although not very common, but quite dangerous. Its main symptoms are detailed in the section that you will find by clicking on the link.

Treatment

Myelitis is treated in stationary conditions.

Medical therapy

Includes reception:

antibacterial agents;
glucocorticosteroids (prednisolone in a daily dosage of up to 120 g) for viral, allergic and idiopathic forms;
adrenocorticotropic hormones;
potassium orotate;
anticholinesterase agents, often together with muscle relaxants with increased tone;
diuretics (furosemide, etc.);
antipyretic in case of fever;
analgesics (non-narcotic, narcotic);
glucose with urotropin.

With paralysis resulting from increased tone, thermal procedures are indicated (baths, paraffin, etc.), with flaccid paralysis - electrical stimulation.

Therapeutic methods

detoxification;
dehydration;
ensuring constant emptying of the bladder;
pressure ulcer prevention;
IVL with paralysis of the respiratory muscles;
orthopedic fittings.

At the end of the acute stage, the following are carried out:

vitamin therapy (may be prescribed in the acute period);
physiotherapy (UHF can be used at the beginning of the disease);
massage;
exercise therapy complexes;
treatment in sanatoriums, resorts.

Surgery

At the last stage of the disease, with severe motor disorders due to high tone, a neurosurgical operation can be performed.

At the acute stage, surgical therapy is implemented when:

the presence of purulent foci;
significant manifestations due to compression of the spinal cord.

Non-traditional methods of treatment of myelitis

Treatment of myelitis with folk remedies is carried out after consultative communication with the doctor and includes compresses:

from potatoes with honey;
on the neck from a mixture of vodka, mustard, aloe, propolis.

Homeopathic treatment is carried out by a specialist in this field based on the observed manifestations (prescriptions are adjusted as symptoms change) and the characteristics of the patient. Episodes of application for myelitis Picricum acidum, Lathyrus sativus, Alumina in the required dilution are described.

Hirudotherapy also belongs to non-traditional methods of treating myelitis.

The video shows what leeches treat and how a hirudotherapy session will help:

Prognosis and recovery after illness

Myelitis can develop with:

stabilization and gradual decrease in symptoms;
preservation of manifestations for life without deterioration (typical of acute transverse myelitis);
progression of pathology, the spread of inflammation to the lower part of the brain.

In myelitis of the lower thoracic and lumbosacral (due to violations of pelvic functions), as well as cervical (due to the proximity of the muscles responsible for breathing, etc.) - the prognosis is unfavorable.

Purulent myelitis often ends in death.

Consequences and preventive measures

Severe spinal cord injury in purulent forms of the disease leads to paralysis of the arms and/or legs.

Even after a mild course of the pathology, sensory disturbances, leg cramps, and problems with motor actions persist.

Frequent complications of myelitis include the formation of bedsores and impaired mobility of the joints of the injured limb.

Prevention

Specific measures are aimed at preventing secondary myelitis and include vaccination against:

measles;
poliomyelitis;
chickenpox;
parotitis, etc.

Myelitis poses a serious threat to the restoration of normal activity and life of the patient. Prompt treatment increases the likelihood of a positive outcome. Vaccination of a number of childhood diseases significantly reduces the risk of secondary infectious myelitis.

Inflammation of the spinal cord, capturing a large part of its diameter with damage to both gray and white matter.

The process can spread to the entire diameter of the spinal cord ( transverse myelitis) or is manifested by scattered foci of inflammation in various segments of the spinal cord (disseminated, disseminated, myelitis).

Causes of the disease

Allocate infectious, intoxication and traumatic myelitis. Infectious myelitis can be primary, caused by neuroviruses (Herpes zoster, poliomyelitis, rabies viruses), tuberculous or syphilitic lesions. Secondary myelitis occurs as a complication of general infectious diseases (measles, scarlet fever, typhoid, pneumonia, influenza) or any purulent focus in the body and sepsis.

Myelitis Symptoms

Myelitis occurs acutely or subacutely, often against the background of general infectious symptoms (fever, malaise, chills). There are back pains radiating to the areas corresponding to the zones of innervation of the affected roots; paresthesias can also occur in these areas.

Following the pain syndrome below the level of the spinal lesion, paralysis, conduction disturbances of sensitivity and pelvic disorders develop. In the acute period, regardless of the level of damage, paralysis is sluggish: the tone in the paralyzed limbs is reduced, deep reflexes are difficult or absent. However, already in the early stages of the disease, Babinski's symptom or other pathological reflexes are detected.

With myelitis of the cervical and thoracic localization, after a few days, flaccid cuts gradually transform into spastic ones. As a rule, trophism suffers, as a result of which bedsores develop rapidly. In severe cases, myelitis is complicated by septicopyemia, the entry gates of superinfection are primarily bedsores and urinary tract. In the cerebrospinal fluid, an increased protein content and pleocytosis are usually noted - neutrophilic in pyogenic infection and lymphocytic in cases of a viral or allergic nature of the disease. The Queckenstedt test usually detects normal patency of the subarachnoid space; only occasionally a block is detected due to either a sharp edema of the spinal cord (edematous, pseudotumorous myelitis), or an adhesive process.

The course of the disease may be different. In favorable cases, after the acute period has passed, the process stabilizes, and later the spinal symptoms regress to one degree or another. In some cases, a picture of a transverse spinal cord lesion persists for life.

In the most malignant cases, there is an ascending progression of myelitis, in which inflammation can spread to the brainstem. Subacute necrotizing myelitis is more often observed in elderly people, often with chronic cor pulmonale. The clinical picture is characterized by increasing spastic-atrophic paresis of the legs, variable sensitivity disorders and pelvic disorders. Damage to the lower parts of the spinal cord and cauda equina grows over several years, gradually spreading upwards. The content of protein in the cerebrospinal fluid is increased.

Myelitis Treatment

Treatment is carried out in a hospital. Antibiotics and sulfonamides are prescribed in the usual dosages, a 40% solution of hexamethylenetetramine (urotropine) is administered intravenously, 8-10 ml, 40% glucose solution, 15-20 ml. From the first days of the disease, it is very important to observe careful skin care in order to prevent bedsores. It is necessary to monitor the cleanliness of bed linen. A rubber circle or cotton-gauze rings should be placed under the protruding parts of the body. Several times a day, the skin is wiped with camphor alcohol, the position of the patient is often changed.

When bedsores appear, quartz irradiation is prescribed, they are treated with a 5% solution of potassium permanganate, ointment dressings are applied (Vishnevsky ointment, sulfadimezin or synthomycin emulsion). With urinary retention, repeated catheterization of the bladder is performed under strict aseptic conditions. The bladder is washed with a 2% solution of boric acid, potassium permanganate (0.1: 200), silver nitrate (1: 2000). When cystitis or pyelocystitis occurs, levomycetin (0.5 g 4 times a day), biomycin (0.2 g 4-5 times), and plenty of fluids are prescribed.

For the prevention of contractures from the first days of the development of paralysis, it is necessary to monitor the position of the limbs, laying them in the desired position with the help of sandbags. Already in the early stages, passive and then active gymnastics and massage should be used.

In order to improve motor functions, prozerin, dibazol, B vitamins are prescribed. To reduce muscle tone in spastic paralysis, mellictin 0.02 g is used 2-3 times a day. After 2 months from the onset of the disease, it is advisable to use iontophoresis with iodine, diathermy on the area of the lesion. In some cases, orthopedic treatment is indicated.