Mielopoliradikulonevrit (myelopolyradiculoneuritis) - simultaneous infectious lesions of the spinal cord, roots and peripheral nerves of extremities. This syndrome can be divided into two groups: the first - the process is localized mainly in the spine and nerve trunks, and the symptoms of spinal cord appear later and poorly expressed; in the second - there are phenomena of myelitis, and the peripheral nervous system is abortifacient nature, nerezko expressed and relatively quickly. The term "mielopoliradikulonevrit" it would be more correct to refer to the first group of this syndrome. Syndrome mielopoliradikulonevrit more common in subchronic and prolonged the duration of infectious process in General.
Etiology of mielopoliradikulonevrit often contagious. There are primary and secondary forms of this syndrome. In primary M talking about viral damage to nerve roots, nerve trunks and substance of the spinal cord, while the specific virus is not detected; these forms are becoming more frequent outbreak of viral influenza. Secondary PM is a common complication of an infectious disease or a result of the spread of the peripheral nerves, nerve roots, shell and the substance of the spinal cord local infectious foci outside the nervous system.
Pathological anatomy. Mielopoliradikulonevrit characterized by inflammation in the membranes and parenchyma nerves and roots in the spinal ganglia. In these departments, and the shells and the substance of the spinal cord see light perivascular infiltration lymphoid elements, a large blood vessels, and in the matter of the spinal cord celebrate the lungs and is often reversible changes of nerve cells of the front and rear less horns. Particularly noteworthy vascular disorders in all affected parts of the nervous system. At the forefront are the perivascular edema, often diapedetic hemorrhage, mainly capillary, protein impregnation vessel walls, elastomers (sometimes in the absence of marked infiltration of the vessel wall changes in the cells of the spinal cord are ischemic character).
Over and symptoms. The most common variant of mielopoliradikulonevrit with a pronounced at the beginning of the disease is more or less stable radicular syndrome (see Radiculitis), with a pain radicular nature, paresthesia in the limbs and weakness in them. In further developing the paresis and paralysis with easy atrophy of the muscles and soft severe spinal symptoms and pathological reflexes (symptoms Babinsky, Oppenheim and less Rossolimo).
In other cases, first in the clinical picture appear polyneuritises symptoms (see Polyneuritis): pain and parestesia in limbs, fatigue, muscle limbs, muscle atrophy in distal departments, which later joined radicular and spinal symptoms.
In rare cases, especially when a more severe disease course, along with radicular and neuroticeski symptoms can be more expressed malaichuka phenomena (see Myelitis) with the increase of tendon reflexes, klausami stop and light violations on the part of the pelvic organs. Sensitive disorders consist of light conductor of violations against the background of radicular and polyneuritises disorders of sensitivity. Often suffers deep sensitivity.
Musculoskeletal disorders are given a kind of picture of disorders of the peripheral motor neuron along with more or less damage to the Central of the neuron. Consequently, there is an uneven distribution of paralysis - affects the muscles of the hands and feet, legs and one hand; in one limb has paresis, and the other with paralysis. In most cases, the distribution of paresis distal, but it proximal; in some cases, there are the paralysis of the muscles of the trunk and the back (the patient moves from a lying to a sitting or standing position, as mypath,- stupenchataya).
Reflexes pain and tension are common, especially symptom Lasaga; symptoms of Cernica and Brudzinskogo expressed less constantly. In most cases occurs muscular hypotonia, rarely hypertension, especially in the lower extremities. Muscle atrophy was observed in a significant number of cases, accompanied by change of elektrovozoremontnij muscles and nerves. The cerebrospinal fluid is almost always changed, often on the type balavariani dissociation; sometimes moderate lymphocytosis observed in the beginning of the disease and quickly disappears, and increased protein stand. The pressure of the cerebrospinal fluid, most of the patients are normal. Tonic and pain reflexes, radicular and distal types of disorders of sensitivity, impaired muscle feelings, belovolova dissociation in the cerebrospinal fluid are signs of localization of the main process in the it segment of the roots.
The forecast. The disease when mielopoliradikulonevrit in most cases, sub-acute, protracted, sometimes with remissions. The outcome in a significant number of cases favourable. Death happens only when the disease, current type ascending paralysis Landry, with lesions of the respiratory muscles. Often there are residual effects in the form of paresis and paralysis.
Treatment in the beginning of the disease is determined mainly by etiology. Unspecified infectious etiology, intravenous injection of glucose, urotropine, antibiotics; recommend Dibazol, strychnine, antisense funds (calcium chloride, diphenhydramine, pipolfen); the strong pain - killers novocaine (intravenously), multivitamin. Good effect is hormonal drugs - cortisone, prednisone. In the late period of the disease recommend massage, remedial exercises, galvanic current, geodinamicheskie Bernard currents, hydrogen-sulphidous baths, UHF; further - and-Spa treatment at mud and mos resorts.
The respiratory disturbances produce a tracheotomy and establish long intratracheal artificial respiration (the office of Angstrem). You can also apply a number of respirators - iron lungs.