Myelitis

Myelitis - inflammation of the spinal cord. Myelitis is primary and secondary. Primary mielita called neurotropic viruses. Secondary mielita are much more common primary arise with the common infectious diseases: influenza, typhoid, measles, and so on infectious Pathogens and their toxins penetrate into the spinal cord through the lymphatic and blood vessels and stimulate him to more or less severe inflammatory and dystrophic changes. In viral Milito in one degree or another affects the membranes of the spinal cord, roots and nerve trunks.
Myelitis usually develops acutely: the temperature rises, there chills, General malaise, often expressed meningeal symptoms (see Meningitis). In blood marked leukocytosis, shift leukocyte left, accelerated ROHE. Within a few hours or 1-2 days after the onset of the disease have symptoms lesions of the spinal cord, depending on the level of destruction. While often celebrated the defeat of the cross-section of the spinal cord.
Symptoms of myelitis are formed from paralysis (see Paralysis, paresis), disorders of sensitivity, impaired function of the pelvic organs and trophic disorders.
The localization of the inflammatory process in the area of the upper cervical segments observed spastic paralysis four limbs and violations of all kinds of sensitivity. With the defeat of thickening the cervical spinal cord noted flaccid paralysis of the arms and spastic paralysis of the legs with disorders of all kinds of sensitivity below a level of destruction. With the defeat at the level of the thoracic segments notes spastic paralysis of the legs with disorders of sensitivity below a level of affected segments of the spinal cord. With the defeat at the level of the lumbar thickening of the spinal cord is celebrated flaccid paralysis of the legs. At the beginning of the disease, there is a delay of urine and constipation, which are then replaced by the incontinence of urine and feces. May later develop pressure ulcers, leg edema, increased sweating. The pressure of the cerebrospinal fluid is increased, the number of cells and protein in it increased. Neurological symptoms reaches its maximum during the first days of illness and lasts for several weeks or months. Reverse development when myelitis happens slowly and gradually. First restored to the sensitivity and function of the pelvic organs, later - movement in limbs.
The prognosis depends on the location and severity of the process. Possible recovery, improvement, stabilization of the increase of the pain. No improvement within six months of the disease is a poor prognostic sign. Worse prognosis in cases bottom-up process and accession pneumonia, cystitis, pyelonephritis, extensive bedsores.
Should differentiate with polio, multiple sclerosis, spinal cord injury and especially with spinal stroke, sometimes leading to the development of necrosis of brain tissue and paralysis of limbs.
Treatment is carried out in the hospital. Prescribe antibiotics and sulfonamides in normal dosage, intravenous 40% solution of hexamethylenetetramine (urotropine) on 8-10 ml 40% glucose solution for 15-20 ml From the first days of the disease it is very important to keep a careful skin care with the aim of preventing bedsores. It is necessary to monitor the cleanliness of bed linen. Under exposed areas of the body should put a rubber circle or cotton-gauze rings. Several times a day, wipe the skin with camphor spirit, often change the position of the patient. When sores are prescribed radiation by quartz, process them a 5% solution of potassium permanganate, impose ointment dressing (Vishnevsky ointment, sulfadimezida or syntomycin emulsion). At a delay of urine are being re-catheterization of the bladder under strict asepsis. The bladder is washed with a 2% solution of boric acid, potassium permanganate (0,1 : 200), nitrate of silver (1 : 2000). When cystitis or pielotsistit appoint chloramphenicol (0.5 g 4 times a day), biomitsin (0.2 g 4-5 times), excessive drinking. For the prevention contractures from the first days the development of paralysis is necessary to monitor the position of the limbs, putting them in position with the help of bags with sand. Already in the early stages it is necessary to apply passive, and then active gymnastics and massage.
To improve motor functions prescribed neostigmine, Dibazol, vitamins Century To reduce muscle tone in spastic paralysis apply mellitin 0.02 g 2-3 times a day. After 2 months of onset is advisable to use iontophoresis with iodine, diathermy on the area of the lesion. In some cases shown orthopedic treatment.

Myelitis (myelitis; from the Greek. myelos - brain - inflammatory disease of the spinal cord infectious, toxic and traumatic aetiology. With the development of inflammatory process in the gray matter of the spinal cord talking about polio (see); if the process is localized only in the white matter, developing alopecia myelitis, and in the process, current and in the white and gray matter, is disseminated and necrotic myelitis. M. S. Margulis (1940) distinguishes between two subspecies of myelitis: focal M phenomena cross lesions of the spinal cord (myelitis transversa) and disseminated M. in the form of scattered sources through clinico spinal cord. For disseminated M. it also classifies, and expected outcome. Currently, M. consider as an independent clinical-anatomical form. A special group comprises those cases when to spinal phenomena join the symptoms of brain lesions - encephalomyelitis (see).
Etiology. Infectious M. and encephalomyelitis described after various infections, endocarditis, pyelonephritis, rheumatism and other Purulent processes in the body can give purulent myelitis; syphilis and tuberculosis can cause both acute and chronic M. there are cases M. and encephalomyelitis after vaccination (post-vaccination). In recent years, described M. and encephalomyelitis with toxoplasmosis. A significant number M is called neurotropic viruses. Toxic M. and encephalomyelitis can develop after acute and chronic lead poisoning, carbon monoxide, and sometimes during pregnancy and childbirth.
In the development of compression myelitis play an important role extramedullary tumors, TB lesions of the spine and meninges. In recent years, described compression Meters with the defeat of intervertebral disk hernia, Smile. Traumatic M can occur when penetrating injuries of the spine; with closed injury of the spine marked pockets softening with hemorrhages in the matter of the spinal cord.


Pathological anatomy. Malaichuka centers, especially in severe cases, M, you can already see with the naked eye. Marked overall increase, hyperemia and softer consistency of the brain. The border between the white and gray matter smoothed. M. S. Margulis Discerner of the nature of the process two forms of focal M: vascular inflammatory and alterative. The main form should be considered first, when in the process prevails vascular-inflammatory tissue reaction with lymphoid infiltration around blood vessels. In the area of lesion vessels dilated, there are low perivascular hemorrhage, increased reproduction glia, especially of microglia in the white matter. The essence of the pathological process when myelitis is a nerve fibers disintegration with damage to the myelin sheath, and then to the axis of the cylinder. The centers of demyelination occupy different parts of the white matter. Ganglion cells of the spinal cord in the inflammation with symptoms of Tyrolese and atrophy. To alternative form of focal acute Meters belong to those cases when there are hemorrhage and heart attacks the spinal cord on the basis of thrombosis soft meninges or Vysocany.
If the expected outcome along with changes in the spinal cord find neuritis optic nerves with demyelination their fibres, changes inflammatory nature in the trunk, in the cerebellum and the brain as well as in protein and vascular shell eyes. In subacute necrotizing M describe necrosis with preferential localization in the gray matter, but with capture and white. When syphilitic Milito inflammatory process affects the beginning of the shell, and the vessels of the spinal cord, and the substance of it is affected by secondary develop hemorrhages and softening the tissues of the spinal cord. The phenomenon of demyelination is most pronounced in syphilis in the rear pillars. When M. tuberculosis may be the spinal cord compression burst into the spinal canal cheesy masses or resulting from tuberculosis Dura. In the spinal cord may develop TB bumps to changes of vessels, cells and fibers white matter.
Pathogenesis. Acute myelitis occurs in some cases hematogenous route with breach blood-brain barrier. In most cases, the lesion of the spinal cord in acute M. lymphogenous origin. The nerves and the roots of the infection reaches the epidural space, and hence through the lymph system Dura the virus spreads on the subarachnoid space and the substance of the spinal cord.
Toxic M is in the nature of degenerative changes. In these cases, they say, often not on Meters, and about myelosis (see Funicular myelosis).