Myelitis

Myelitis is an inflammation of the spinal cord tissues. This pathology is rare in modern medical practice, but it poses a threat to health and in difficult cases leads to disability.

The content of the article:
Causes of development and classification of myelitis
Pathogenesis of myelitis
Symptoms of myelitis
Diagnosis of myelitis
Treatment of myelitis
Prevention and prognosis of myelitis
Myelitis
It can have different localization locations: cover the entire spinal cord or several of its departments. Most often, transverse myelitis is observed, sometimes called focal. The transverse type of myelitis is easier to treat than others, but carries no less risk to the patient’s performance, since it violates the integrity of the spinal cord tissues.

Causes of development and classification of myelitis
Myelitis can be triggered by a variety of causes and can occur in different scenarios. Most often, the cause of its development is an infection. Pathogens include influenza, scarlet fever, typhus, polio, pneumonia, rabies, measles and other infectious diseases. The consequence of such conditions is most often transverse myelitis — inflammation in the most acute form.

The second reason why the development of myelitis begins is intoxication, which entails inflammation. In addition, injuries that affected the spinal cord, incorrectly performed injections of drugs and punctures should be considered as the cause of myelitis.

In addition to the main causes listed above, they may include factors such as hypothermia and all kinds of immunosuppressive conditions.

According to the etiology , myelitis is classified into five types:

viral;
infectious;
traumatic;
toxic;
postvaccinal myelitis.
According to the mechanism of its development, the disease is divided into primary and secondary types. At the same time, secondary myelitis is a consequence of other diseases.

According to the duration of the course, myelitis is differentiated into three main types: acute, subacute and classical. There are several types of this inflammation and by prevalence. This is diffuse, multi-focal and limited myelitis. Transverse myelitis in this classification belongs to a limited one, since it is a small focus of the disease.

Pathogenesis of myelitis
Acute myelitis can occur hematogenically in the case when there is a violation of the blood-brain barrier. The lesion that the spinal cord undergoes with this type of disease is of lymphogenic origin. Moving along the roots and nerves, the pathology reaches the epidural space. Then it moves along the lymphatic pathways located in the dura mater of the brain, and spreads to all the subarachnoid space. Along with this, there is a lesion of the surrounding tissues and as a result, the inflammation diverges already to the entire spinal cord.

Toxic myelitis implies a degenerative disorder in the tissues. In such cases, specialists often diagnose not myelitis, but myelosis — combined sclerosis associated with a lack of vitamins, in particular vitamin B12. In this case, the posterior and lateral columns of the spinal cord mainly suffer.

Myelitis causes a change in the structure of the substance of the spinal cord. It becomes flabby, swollen, pronounced swelling appears on it. The “butterfly” pattern, seen in the section in a healthy state, loses its clear contours. In the area of the focus of inflammation, hyperemia, small hemorrhages, cell death, myelin decay, as well as infiltration by shaped elements are observed.

Symptoms of myelitis
Among the signs of this neurological disorder, first of all, symptoms characteristic of any inflammation in the body appear. This is the body temperature, often rising to 39-40 degrees or more. At the same time, the usual bone aches, chills, a feeling of fatigue and general malaise may occur for an elevated temperature. In this regard, the first signs of myelitis are often mistaken for typical symptoms of a cold.

Neurological disorders become noticeable later when the lesion manifests itself as pain at the site of inflammation. Transverse myelitis provokes especially severe pain. Uncomfortable sensations spread not only to the back area, but also to the limbs, radiating into the internal organs.

The set of signs of myelitis depends on its stage and place of development. For example, a symptom such as loss of sensitivity, severe numbness and paresis of the legs are observed in cases when the disease affects the lumbar region. These conditions are accompanied by a lack of reflexes and a violation of the functioning of the internal organs of the pelvis.

If myelitis is localized in the cervical region, then its main symptom is difficulty breathing, speech disorders, pain during swallowing. There is also a general malaise, dizziness and weakness.

Myelitis of the thoracic spine is expressed by stiffness of movements and the presence of pathological reflexes. In this case, there may be a violation in the work of some organs.

If such symptoms are detected, it is important to immediately seek professional help, since prolonged inactivity exacerbates the problem as a result of the rapid development of the disease. The stronger the tissue damage, the more difficult it is to return the spinal cord to its previous state, since its structure may change irreversibly. This threatens to lose the ability to work and the ability to fully move.

Diagnosis of myelitis
If myelitis is suspected, a lumbar puncture is a mandatory procedure for analyzing the cerebrospinal fluid. The presence of inflammation is indicated by its traces and the absence of protein. The same study reveals the presence of microorganisms in the fluid, which means that the spine has been infected.

In addition to the puncture, the patient is sent for magnetic resonance imaging or tomography using contrast. As a rule, one of these studies, chosen at the discretion of the doctor, is sufficient. The necessary measures are the use of suboccipital myelography and analysis for the detection of microorganisms and other pathogens of pathologies in the cerebrospinal fluid.

Since myelitis can be the result of a large number of processes, it is necessary to conduct differential diagnostics to accurately exclude diseases such as multiple sclerosis, spinal stroke, cystic arachnoiditis and other pathologies with similar symptoms at first glance.

In addition to these conditions, it is necessary to make sure that the patient does not have epiduritis — a disease with an equally similar clinical picture that requires surgical intervention. In difficult situations, additional research may be required when the doctor prescribes an exploratory laminectomy. Diagnosis of epiduritis involves the study of the affected tissues for purulent foci, root pains and the syndrome of increasing compression of the spinal cord substance, which distinguishes this disease from myelitis.

It is necessary to differentiate myelitis with acute Guillain-Barre polyradiculoneuritis, which differs from it in the absence of conductive disorders of pelvic disorders and spastic phenomena.

Spinal cord tumors, which will need to be excluded during diagnosis, have their own characteristic differences: a slow course, a well-defined stage of radicular pain, a block during cerebrospinal fluid tests, protein-cell dissociations in the cerebrospinal fluid.

Excluding hematomyelia and hematorachis, you need to know whether there is an elevated body temperature among the symptoms, since it is its absence, combined with sudden onset and rapid development, that is a sign of these diseases. Hematomyelia causes damage to the gray matter, and with hemorrhage under its shell, the patient has meningeal symptoms. Such pathologies often develop as a result of injuries.

Acute transverse lesion requires the exclusion of cerebrospinal circulation disorders and multiple sclerosis, although the latter is always accompanied by signs such as white matter damage in certain areas, scattered damage not only to the spinal cord, but also to the brain, a decrease in the intensity of symptoms after a few days.

Myelitis also needs to be differentiated with chronic meningomyelitis, characterized by slow progression at normal temperature. Meningomyelitis can be caused by syphilis, detected by serological reactions.

Treatment of myelitis
Treatment of myelitis depends on how much the back of the brain is affected and which segment of it is affected by inflammation. Acute myelitis is the most complex and severe form of the disease, in which the patient requires urgent surgical intervention. The operation eliminates the pressure on the vertebrae and spinal canal, which leads to painful sensations. The high temperature accompanying myelitis is relieved by a course of antibiotics and the removal of inflammation.

Any myelitis needs urgent treatment, otherwise the motor function may be lost forever. The course of myelitis therapy, carried out with already bedridden patients, includes measures to combat bedsores: skin treatment with camphor oil, regular change of bed linen, lining of rubber rings. If bedsores do appear, excision of damaged tissues is performed and a bandage is applied with Vishnevsky ointment, penicillin or tetracycline. Prevention of new bedsores is carried out with the help of ultraviolet irradiation of the buttocks, sacrum and feet.

Along with bedsores, patients may experience a disorder of the pelvic organs. The cause of these failures is an ascending urogenital infection accompanying myelitis, which also needs monitoring and appropriate treatment. Initially, anticholinesterase drugs are used to remove urine. If they are ineffective, catheterization and washing of the bladder with antiseptic solutions are necessary.

To restore the patient’s ability to fully move, the doctor prescribes dibazole, proserin and vitamin B. Taking these medications is most often combined with passive gymnastics and therapeutic massage.

Myelitis in any form is an inflammatory disease in which maximum doses of broad—acting antibiotics are required. To reduce the intensity of pain, antipyretics are used simultaneously with ACLT of 40 units twice a day for 2-3 weeks and glucocorticoid hormones of 50-100 mg per day. The latter can be replaced with dexamethasone or triamcinolone.

Prevention and prognosis of myelitis
There is no specific prevention in this case. Considering that myelitis is a consequence of other diseases, injuries and various kinds of interventions, prevention in this situation is advisable to consider the prevention of diseases that will be its causes. These include infectious infections: polio, mumps, measles and the like. As one of the means to combat them, experts recommend vaccination. Preventive measures can also include timely treatment of other infectious diseases when their first symptoms appear.

The prognosis depends on how badly the patient’s spinal cord was affected. With timely adequate treatment, improvement occurs after six months, and full recovery — after 1-2 years. If there is no positive dynamics by this time, we should talk about disability.

The localization area also plays a significant role. So upper-neck myelitis can become a direct cause of death. Thoracic and lumbar myelitis without timely diagnosis and competent therapy leads to loss of motor function of the lower extremities. The prognosis is significantly suffocated if myelitis is accompanied by the addition of other pathologies: cystitis, pyelonephritis, pneumonia and frequent extensive bedsores.

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