Encephalomyelitis

Encephalomyelitis is an inflammation of the brain and spinal cord toxico-allergic or viral etiology. In the brain, spinal cord appear multiple foci of necrosis, the breakdown of myelin, vascular and inflammatory reaction. Encephalomyelitis can develop in children and adults with infection, intoxication, or be independent disease (primary acute disseminated encephalomyelitis).
Encephalomyelitis divided into primary, resulting in the defeat of neurotropic viruses brain and spinal cord, and secondary, which are developing on the background of previous infection or after a certain period after vaccination.
In the development encephalomyelitis great role is given to allergic reactions that occur in response to the introduction of the virus or autouniversal.
Acute disseminated encephalomyelitis - viral disease with sudden onset, high fever, headache, dizziness, vomiting, decreased vision, pain in the extremities. Patients are defined paresis, and paralysis of limbs with increased muscle tone and reflexes, coordination disorders with staggering when walking, impossibility to make subtle movements (writing, eating, to keep the dishes, buttoning clothes, hair, wash), appears trembling limbs. Often there is staccato, slurred speech, podergivani when eating, urination disorders. After 2-3 months. there comes a partial regression of the symptoms, but often musculoskeletal and coordinatory violations remain. The disease trudnootdelema from multiple sclerosis (see). For the latter characterized by the wave period, a change of one of lesions of the nervous tissue others, the gradual worsening of the defect with every aggravation of the disease. Forecast encephalomyelitis generally unfavorable, in most cases, there are persistent residual effects (paralysis, paresis).
Rabicheskogo postvaccinal encephalomyelitis is rare, refers to the secondary encephalomyelitis. 10-20-and the day after the start of vaccination against rabies revealed signs of brain and spinal cord, sometimes in combination with lesion of the peripheral nerves and roots. A headache, back pain, and fever. In a few days developed paresis and paralysis of limbs, increase of the tendon reflexes, there are pathological reflexes, difficult urination up to the full retention of urine. Patients complain of muscle pain, palpation painful nerve trunks, when the tension of the roots of pain to grow sharply. Blood is marked leukocytosis, possible albuminuria in the urine, cerebrospinal fluid moderate increase of proteins and cells. Forecast: in the light cases there is a complete restoration of the lost functions, in more severe - there are lasting consequences.
Treatment. If you suspect encephalomyelitis the patient should be referred to a neurologist. Treatment should be carried out in the hospital. In all cases encephalomyelitis (primary and secondary) recommended vitamins: 5% solution thiamine chloride (B1) 1 ml intramuscularly, 2.5% solution of pyridoxine (B6) and 1 ml intramuscularly, cyanocobalamin (B12) 200 mg intramuscularly, ascorbic acid (C) inside 0.2 g with routine 0.02 g 3 times a day. Prescribe prednisone for 20-30 mg per day for 10-20 days (to cancel the drug should be cautious, gradually reducing the dose), and antihistamines - diphenhydramine, pipolfen, suprastin (in the usual dosage) and dehydration drugs - magnesium sulphate 25% solution 10 ml intramuscularly, lasix inside 25 mg 3 times a day. At occurrence of respiratory disorders in patients receiving assistance in special medical institutions. Apply heart drugs, pain medication.
For the prevention of rabies encephalomyelitis avoid cooling or over at the time of vaccination, prohibits the consumption of alcohol, a trained person should be exempted from heavy physical work and night shifts. According to the testimony applies gamma globulin or Hyper gamma globulin.

Encephalomyelitis (from the Greek. enkephalos - the brain and myelos - spinal cord) - inflammation of the brain and spinal cord syndrome multifocal lesions of the Central nervous system in many infectious and infectious and allergic diseases.
Acute encephalomyelitis occurs as one of the clinical variants in primary encephalitis, and also at common infectious diseases, especially in acute childhood infections (measles, rubella, chickenpox, and other) or after them. In common pathogenesis and pathomorphological changes these forms of diseases unite in the group of so-called preinfection of encephalomyelitis. Pathogenetically close to him encephalomyelitis that occur after vaccination against smallpox, vaccination against rabies, tick-borne encephalitis, Tivo-partypany diseases, intestinal infections, as well as after the introduction of drugs in the blood serum.
Encephalomyelitis with primary defeat of gray matter (polio, tick-borne and epidemic encephalitis, a disease Bourne and others) called polioencephalomalacia. When preinfection, postvaccine and acute disseminated encephalomyelitis more affected white matter of the brain and spinal cord (leukoencephalitis), sometimes in combination with lesions of spinal roots (encephalomyelopathy) and traumatic brain, in particular the visual (opticoncept expected outcome), nerves. In the acute phase in the process often involves and of the meninges (meningoencephalomyelitis). Syndrome of chronic encephalomyelitis motologichesky not separated from the underlying disease, such as cerebrospinal syphilis or some forms of multiple sclerosis.
In addition to these secondary encephalomyelitis, there is also the primary acute disseminated encephalomyelitis. Acute disseminated encephalomyelitis considered as clinical form in the group demyelinating lesions of nervous system. The disease is found, the highest number of cases described in European countries; sick children and the elderly, however, is dominated by persons of young age.
Etiology. Put forward various theories of etiology encephalomyelitis: toxic, vascular (blood clots in the Central nervous system), lipolytic, infectious, allergic. For acute disseminated encephalomyelitis the most justified assumptions about infectious or neiroallergicescoe its nature. Soviet researchers (M. S. Margulis, V. D. Solov'ev, A. K. Shubladze, and S. Ya, Russian) was able to extract from blood, cerebrospinal fluid and brain dead patients with acute disseminated encephalomyelitis identical strains of the virus, according to its antigenic and biological properties similar to rabies virus and non-viral pathogens other diseases (see Multiple sclerosis).
The experience of clinical study of acute disseminated encephalomyelitis using specific (serology) methods gives grounds to believe that these are diseases of various etiologies. Not all patients the diagnosis is confirmed by detection in the blood of specific antibodies to the virus of acute disseminated encephalomyelitis (, A. Panov, A. P. Zinchenko). The similarity of the clinic and pathomorphology of acute disseminated encephalomyelitis to vaccine encephalomyelitis gave grounds for allergic theory of pathogenesis and etiology of the first. This theory is widely recognized after the animals after repeated parenteral introduction emulsions and extracts normal brain tissue was obtained experimental encephalomyelitis. From the positions of allergic theory demyelinating encephalomyelitis are a group of diseases, United by the common pathogenesis (neuroallergic) when a variety of etiological (sensitizing) factors.
Pathological anatomy. The main features of encephalomyelitis should include seadistustefaili process mainly in the white matter of the brain and spinal cord. The changes relate mainly venous and prekapilliarny vessels. Also typical multiple foci of demyelination with the collapse of the myelin sheaths and only a partial defeat of the axis of the cylinder.
As in the white and gray matter meet glioznogo knots from proliferating meso - and microglial elements. Neuronophagia is rare. M. S. Margulis emphasizes the frequency disseminated miliary and larger necrosis foci that are not related to changes of vessels. He relates them to the earliest and most basic features pathomorphology of acute disseminated encephalomyelitis, characteristic for infectious viral lesions of the nervous system.
A distinct inflammatory changes with secondary degeneration of fibers frequently detected in the roots, nerve trunks, epidural tissue and skin.


The clinical picture of the disease is varied. There are various combinations of symptoms hemispheres and barrel, cerebellum, spinal cord, often in combination with damage to the cranial nerves and the roots. To diagnose encephalomyelitis important mnogozadachnosti process and primary defeat of the white matter of the brain.
The disease develops more often acute, moderate (up to 37.5-of 38.5 degrees) increase body temperature. Initial manifestations have mnohocetny character, marked diverse parestesia in limbs and torso, decreased vision, diplopia. Soon these symptoms can join Hemi - and paraparesis of the Central type, disorders of the statics and coordination. Spinal symptoms usually are multifocal multiple character. Sometimes at the beginning of the disease are observed more or less severe cerebral and meningeal symptoms: headache, nausea and vomiting, oglushennosti or confusion. However, the sense of violation and other cerebral symptoms, and meningeal syndrome, expressed moderately.
Changes in the spinal fluid is fickle and manoharachary. More common belovolova dissociation with moderate (to 1 per thousand) increased protein content in normal lymphocytosis, rarely moderate pleoticus.
In some cases, the pattern of disease significant symptoms roots: pain, paresis and discomfort in the feet and hands, muscle atrophy. Such patients is striking combination of symptoms Central and peripheral nervous system. In addition to the optic nerves (retro-bulbar neuritis), affects the eye, discharge, facial nerves. Occasionally develop symptoms bulbar palsy.
Obstipation symptoms usually expressed moderately. Body temperature drops to normal 3-7 days; sometimes the disease develops at a normal or low temperature. Changes of blood irregular and malopitatelny; in some patients, there is a leukocytosis (up to 10 000 1 mm3), and a few accelerated ROHE.
The disease is different phases rise symptoms and often significant reversibility even in severe paralysis. In most patients in the clinical outcome remain moderate pyramid and cerebellar disorders. Radiculoneuritis symptoms usually disappear completely. When neuritis optic nerves vision remains reduced, identified persistent scotomas or blindness. With cerebral paresis recovery is more complete than when spinal. Occasionally arise later epileptic seizures. Along with this, some patients were observed almost complete restoration of function, in spite of serious violations in the acute phase of the disease. There are indications of the possibility of recurrent acute disseminated encephalomyelitis. Known observations that indicate the possibility of transition of acute disseminated encephalomyelitis chronic with a picture of multiple sclerosis; on the other hand, multiple sclerosis relapse proceeding with clinical manifestations of the type of acute disseminated encephalomyelitis.
The range of clinical manifestations acute disseminated encephalomyelitis accurately delineate impossible due to the lack of generally accepted criteria of its diagnostics. D. S. Footer highlights: 1) the primary type of lesion with all departments of the nervous system (encephalopathyaltered); 2) optionsargument - combination neuritis optic nerves with cerebral or spinal paralysis (expected outcome options.element); 3) disseminated with transverse myelitis or partial lesion of the spinal cord, sometimes with a syndrome of the brown-séquard; 4) polioencephalomalacia with symptoms stem cores and gray matter of the spinal cord. Other classifications syndromes are different in detail.
Apparently, some patients with acute advanced retro-bulbar optic neuritis can be attributed to the initial manifestations or monocompany forms of acute disseminated encephalomyelitis.
Mortality in acute multiple encephalomyelitis varies; for the total data, it does not exceed 8%.
The diagnosis is based on such features clinics and course of the disease, acute beginning against mildly obstipation brain and meningeal symptoms, rapid disease progression by type of occurrence of new lesions of different departments of the Central and peripheral nervous system, mnogozadachnosti destruction and the predominance of the conductive disorders, frequent damage of the optic nerves. The diagnosis of acute disseminated encephalomyelitis at the present stage of knowledge characterizes only the clinical syndrome, determining the etiology of the process. Therefore, in all cases, you should try to find out the possible etiological factors (communication with other diseases, immunization, injection of serum drugs and other).
In some cases when suspected link acute disseminated encephalomyelitis with a specific viral disease (choriomeningitis, tick-borne encephalitis, and so on) can be used specific diagnostic methods. It is advisable to study the blood of patients in the neutralization reactions and of complement fixation with the virus of acute disseminated encephalomyelitis. For diagnostic purposes can also be used allergic skin reaction to intradermal injection of 0.5 ml of vaccine of Margulis-Shubladze. This will of polymorphic group of diseases, United clinical form of acute disseminated encephalomyelitis, select etiological uniform variant of the disease caused by the virus encephalomyelitis.
Treatment. When the diagnostic tests confirm the etiological role of a virus of acute disseminated encephalomyelitis, it is expedient to apply the vaccine of Margulis-Shubladze conventional scheme. The remaining patients, among symptomatic funds can be useful antisense drugs and hormones (diphenhydramine - 0.05 g 2 times a day during a month, pipolfen 0,025 g 2 times a day, prednisone 5 mg under the scheme, dexamethasone and other) in combination with antibiotics and vitamins B1 - 5% solution of 1 ml intramuscularly 25 injection) and S. After acute apply generally accepted methods of rehabilitation therapy: vitamins B12 - from 200 to 500 mcg daily, 20 injections, B1, amino acids, biogenic stimulators, antiholinesteraznah (proserin, in injections of 0.05% - 1 ml subcutaneously) and stimulating drugs, medical gymnastics, massage, phisiobalneotherapy.