Meningomyelitis
Meningomyelitis is a neurological disease characterized by damage to the membranes and substances of the spinal cord. This pathology is considered a complication of brucellosis, syphilis and tuberculosis. It manifests itself with symptoms such as a violation of skin sensitivity and motor functions, root pains, paresthesia. The doctor makes a diagnosis based on the results of CT and MRI, serological examination of blood, as well as examination of cerebrospinal fluid. Treatment of pathology is prescribed depending on its etiology.
The content of the article:
Causes of meningomyelitis
Symptoms of meningomyelitis
Diagnosis of meningomyelitis
Differential diagnosis
Treatment of meningomyelitis
Prognosis and prevention of meningomyelitis
Meningomyelitis
Meningomyelitis refers to an inflammatory process that covers the membrane and substance of the spinal cord. However, in neurology, pathology is not considered a separate disease, it is one of the complications of other neurological diseases. Usually, the presence of meningomyelitis in a patient indicates that the pathological process has begun to spread in the central nervous system.
Inflammation first covers the membranes of the spinal cord, after which it shifts to its substance and spinal roots. Depending on the affected area, there are three stages of meningomyelitis, each of which is characterized by certain manifestations: meningeal, radicular and symptoms of damage to the substance of the spinal cord. Foci of meningomyelitis are localized mainly in the thoracic region. Pathology is very dangerous for the life and health of the patient, since it provokes the formation of adhesions between the substance and the membranes of the spinal cord, which eventually leads to compression myelopathy.
Causes of meningomyelitis
Meningomyelitis is a secondary pathology that occurs against the background of rheumatic diseases and infections such as scarlet fever, syphilis, measles, tuberculosis, brucellosis. In such diseases, meningomyelitis develops due to the ingress of a pathogen with blood flow into the meninges.
One of the most common causes of the disease is syphilis. In particular, the greatest harm to the nervous system is caused by meningovascular syphilis, which is characterized by severe damage to the substance and membranes of the spinal cord, thrombosis of blood vessels. This is a chronic disease, as a result of which, over time, the spinal membranes thicken due to the active growth of connective tissue. Then adhesions are formed, which provoke compression of the spinal cord substance.
Meningomyelitis often becomes a complication of tuberculosis. The focus of tuberculosis is usually localized in the bronchial lymph nodes or lungs. Mycobacteria from the focus enter the meninges with blood flow. The result of this process is that miliary tubercles gradually begin to form on the soft meninges, which provoke the appearance of serous fluid and a local allergic reaction. If, at the same time, timely treatment is not provided to the patient, the fluid will eventually begin to be replaced by coarse connective tissue, which will eventually lead to the formation of adhesions. As a result of the prolonged course of pathology, the formation of calcification foci in the substance of the spinal cord is also possible.
Symptoms of meningomyelitis
A variety of diseases can provoke the occurrence of meningomyelitis, each of which differs in a specific clinical picture. However, it is possible to distinguish a number of common symptoms characteristic of meningomyelitis, regardless of its etiology. The disease develops slowly and gradually, but its onset is usually acute. Due to these specific features of the course of pathology, it is possible to distinguish it from diseases with similar symptoms.
At the beginning of the disease, the patient may experience a change in sensitivity in the abdomen, arms and legs. The patient also complains of a burning sensation, tingling, numbness. As the pathology develops, root symptoms also appear: severe shingling pains around the chest, which can even provoke a myocardial infarction or angina.
Immediately after the inflammatory process affects the substance of the brain, the patient will have weakness in the limbs up to their paralysis. Then pathological reflexes, problems with the work of the bladder and rectum will be added to the clinical picture, skin sensitivity will disappear to the level where the focus of inflammation is located. Pathology may be accompanied by short-term remissions, during which the symptoms of the disease may become less pronounced or disappear altogether.
For meningomyelitis, which is a complication of syphilis, the gradual development of limb weakness is characteristic, which eventually turns into paralysis of the legs, and a violation of the functions of the pelvic organs. Meningomyelitis, provoked by tuberculosis, develops extremely slowly, so it is difficult to notice its symptoms. The main manifestation of the disease is compression of the spinal cord by spikes, which leads to arbitrary movements of the limbs and impaired sensitivity. In rare cases, the symptoms of the disease may manifest themselves with root pains.
Diagnosis of meningomyelitis
During the diagnosis of pathology, the doctor should take into account that it is a complication of a more serious and severe disease. That is why the diagnosis should begin with a comprehensive examination of the patient. Methods such as syphilis tests (RPR test, Wasserman reaction), lumbar puncture, tuberculin test, chest X-ray are also used to diagnose the disease.
To find out the causes of the disease, an analysis of cerebrospinal fluid is prescribed. If the pathology has become a complication of syphilis, the results of the study will show a positive Wasserman reaction and pleocytosis. Meningomyelitis, provoked by rheumatic disease, is determined by the presence of lymphocytes in the cerebrospinal fluid. Purulent infection, which has become the cause of pathology, is characterized by an increase in the cerebrospinal fluid of leukocytes.
To determine the tuberculosis etiology of the disease, the following results of lumbar puncture allow: at the first stage of the disease, leukocytes predominate in the cerebrospinal fluid, which are replaced by lymphocytes over time, there is a decrease in glucose levels and an increase in protein levels. The diagnosis can be confirmed by the detection of mycobacteria in the cerebrospinal fluid by staining its smear.
Differential diagnosis
The clinical picture of meningomyelitis resembles the symptoms of many neurological pathologies, so the doctor needs to make a differential diagnosis. Pathology will need to be distinguished from acute myelitis, spinal cord tumor, spinal form of multiple sclerosis. To distinguish meningomyelitis from acute myelitis, the doctor pays attention to the course of pathology. Usually myelitis has a very acute onset, develops due to infection of the body, proceeds violently. Patients have sensory and motor disorders, the formation of pressure sores, fecal and urinary incontinence.
As for multiple sclerosis, it is characterized by a complex of specific symptoms that are never detected in meningomyelitis. Such symptoms include problems with speech, trembling of the hands, involuntary movements of the eyeballs. Meningomyelitis can easily be confused with a tumor of the spinal membranes, especially in the case of the formation of a large number of adhesions that compress the substance of the brain. The presence of a significant increase in the amount of protein in the central nervous system makes it possible to distinguish a tumor from meningomyelitis, despite the fact that the cellular composition has not changed. However, an accurate diagnosis can be made only after an MRI and CT scan of the brain.
Treatment of meningomyelitis
The method of treating the disease depends on which complication of the disease it is. That is, doctors focus on the treatment of the primary disease in order to eliminate its consequence — meningomyelitis.
To eliminate tuberculosis, drug therapy is prescribed, which involves the use of medications such as rifampicin, isoniazid, pyrazinamide. To prevent side effects from taking these drugs, group B vitamins are additionally prescribed .
Patients whose meningomyelitis was provoked by measles need hospitalization. To date, there are no effective drugs for the treatment of measles. Therefore, treatment provides for compliance with measures aimed at normalizing water-salt metabolism and detoxification of the body. Additionally, medications are prescribed to normalize blood circulation in the vessels of the brain.
For the treatment of brucellosis and typhus, the patient is prescribed antibacterial therapy. At the same time, drugs are selected depending on the degree of sensitivity of pathogens to them.
To eliminate syphilis, the patient is prescribed penicillin. However, the outcome of such treatment will be positive if the optimal concentration of the drug is maintained in the patient’s blood for a long time, since only in this case there is a chance of total destruction of the causative agent of syphilis. Therefore, together with penicillin, probenecid is indicated, which is able to delay the excretion of the main drug from the body. Over time, the concentration of penicillin becomes so high that it is enough to destroy microorganisms. Some patients are allergic to penicillin. In this case, it is replaced with medications from the group of cephalosporins.
After the elimination of the underlying disease that caused meningomyelitis, the next stage of treatment of this pathology begins. Namely, after the destruction of the pathogen of pathology, the patient’s body becomes weakened and susceptible to other diseases. Therefore, the doctor prescribes physical therapy, physiotherapy, nutrition, vitamins, restorative treatment in a sanatorium.
Prognosis and prevention of meningomyelitis
The prognosis for a patient with meningomyelitis primarily depends on the reasons that provoked it. The patient’s recovery process is associated with the severity of the disease: the more acute it is, the better it responds to treatment and the faster the recovery of the nervous system takes place. The most favorable for the patient’s recovery are considered meningomyelitis, which have become complications of allergic and infectious pathologies: rheumatism, measles, typhus, brucellosis.
For patients with tuberculosis and neurosyphilis, the prognosis is determined depending on the duration of the disease. The longer a person is ill, the less likely his full recovery is. This is due to the fact that with a slow and sluggish course of pathology, irreversible changes occur in the substance and membranes of the spinal cord. Therefore, there is a high risk that even after eliminating the cause of the pathology, neurological symptoms will still remain. Pathology prevention is aimed at timely detection and treatment of diseases that can provoke it.
