Inflammation of the spinal cord is called myelitis (from the Greek "myelos"). It is the immune response of the human body to an infectious attack, intoxication or traumatic cellular destruction of nerve tissue. Depending on the width of the lesion and localization, the disease can interrupt the connection of the body with the brain or disrupt the irreversible control of the limbs and the functioning of internal organs.
Reasons for the appearance
Varieties of myelitis are divided into two main groups, which are formed according to the order of occurrence of the lesion process:
- Primary. Pathology is the result of direct damage (infection, trauma) to the patientβs spinal cord .
- Secondary The disease develops against the background of another disease or is its complication (that is, a consequence of secondary infection).
There is a simultaneous inflammation of the brain and spinal cord.
Classification
There is a classification according to the mechanism of occurrence of the inflammation process. Depending on this, myelitis is divided into the following categories:
- traumatic;
- infectious;
- idiopathic (etiology is unclear);
- intoxication.
Infections of an infectious nature are produced mainly by the hematogenous method, by means of the blood supply system (the exception is the introduction of the infection into an open wound). The method of penetration of viral infections in primary myelitis involves the direct entry of viruses through the bite of infected people and animals, blood-sucking insects, non-sterile medical instruments into the blood. The most likely causative agents of infectious primary myelitis are neurotropic (with the ability to penetrate into neurons) viruses of tetanus, influenza, measles, chickenpox, rabies, mumps, lichen, polio, various types of herpes (cytomegalovirus, herpes simplex, Epstein-Barr). How else does spinal cord inflammation occur?
Provoking factors of secondary infection
Foci of infection with a secondary type of infection appear in the spinal cord also as a result of the movement of bacteria through the blood supply system. The following pathogens are known:
- fungal (Cryptococcus, Blastomyces, Aspergillus);
- bacteria (syphilis, tuberculosis);
- parasites (trematodes, helminths).
Traumatic sources of inflammation:
- irradiation (high-energy radiation);
- electric shock;
- decompression sickness.
Metabolic disorders:
- pernicious anemia (death of neurons, demyelination, lack of vitamin B12); diabetes;
- chronic liver disease.
In addition to the factors listed above, the inflammatory process in the spinal cord can be triggered by toxic substances (including anesthesia with intervention on the spine), collagenoses (connective tissue diseases), heavy metals, inflammation of the meninges (arachnoiditis), and autoimmune diseases.
Spinal cord inflammation can be caused by the administration of a vaccine for any of the viral diseases listed above.
Development features
The infection enters the spinal cord from the outside either by the hematogenous or lymphogenous method from the primary focus (with lymph or blood). Myelin sheaths or spinal cord nerve fibers become the second route of introduction.
First, infection of the space between and under the membranes occurs, then the main brain tissues (white and gray matter) are affected.
The spinal cord has a division into segments that correspond to the size of the vertebrae. Each segment is responsible for reflexes and transmits signals to the brain of the head and back from a specific muscle group or internal organ. Myelitis, depending on the number of infected segments, is defined as limited (localized), distributed in segments (disseminated) or focal (in unrelated or adjacent segments). Opticomyelitis is distinguished separately when transverse myelitis and optic neuritis are combined, which is distinguished by demyelination.
By localization
According to localization in the brain stem, myelitis is divided into:
- transverse (the affected area is the white and gray matter of the brain in a number of segments immediately);
- anterior (affected area - white matter in the area of ββthe median anterior groove);
- peripheral ( white matter of the brain is affected on the lateral and posterior sides);
- central (gray matter is affected).
The source of inflammation of the gray matter of the spinal cord is the response of the immune system to the presence of a pathogenic factor.
In intensity
The disease according to the intensity of the reaction is defined as:
- Acute that develops quickly, deep tissue damage, there may be several foci of development.
- Subacute. It slowly develops, accompanied by pains of unknown origin, beginning from the lower sections.
- Chronic Over the course of several years, it develops, accompanied by defects in tissue nutrition. The main cause of disease: the first type of T-lymphotropic virus and HIV infection.
The main result of immunity cell activity is neuronal degeneration and demyelination of the closest conducting nerves, which are involved in the scope of the inflammation process. Necrotization of nerve tissue manifests itself in the form of an increase in fragments of cell structures in the cerebrospinal fluid.
Inflammation of the spinal cord is expressed in the form of swelling, tissue swelling, and the blurred border between white and gray matter (seen on MRI). If greatly increased, then there are noticeable blood clots in the capillaries, microscopic hemorrhages, destruction of the cell walls, and decay of the neuronal myelin sheath.
The disease more often (about 40% of cases) affects the thoracic spine and the lower part of the spinal column. According to the frequency of infection, the second is the upper half of the chest, lower back and thoracic-lumbar connection. The neck is rarely infected. More often adjacent pairs of vertebrae or several sections at once (disseminated inflammation) are affected.
Symptoms and treatment of spinal cord inflammation are interconnected.
Symptoms
Symptoms of myelitis are clinically different. Their severity is determined by the degree and level of inflammation of the spinal cord. The main ones are as follows:
- sensitivity defects;
- unpleasant sensations of pain;
- impaired pelvic function;
- paralysis.
The first symptoms of spinal cord inflammation are similar to signs of any infectious process: general weakness, chills, fever up to 39Λ. The presence of neurological pathology is indicated by back pain that can spread to neighboring tissues from the affected area.
A highly developed inflammation of the substance of the spinal cord leads to a loss of sensory and motor functions.
Diagnostic Features
The infectious origin of acute myelitis can be recognized by characteristic signs, its neurological tests confirm. To determine less pronounced chronic and subacute forms, you can use visualization diagnostic methods.
Computed tomography using a contrast medium or magnetic resonance imaging are the leading imaging methods. In addition, myelography is used (not such an effective type of fluoroscopy).
How is the pathogen determined?
The infectious pathogen is determined by bacteriological tests of CSF, studies of exudates and blood in the affected area. Spinal fluid samples are checked for lymphocyte count, protein content, and physical changes. If neutrophils are in large numbers, this indicates the severity of the pathology.
Analyzes and symptoms can talk about diseases that are similar in development mechanism : malignant tumors, multiple sclerosis, epiduritis (epidural purulent abscess), arachnoiditis, polyneuropathy, encephalomyelitis. Using differential diagnosis, the diagnosis is being clarified.
Treatment
It is advisable to treat inflammation of the spinal cord under inpatient conditions or under constant medical supervision. The correct position of the human body in bed, continuous care will ensure minimal tissue and skin damage, since myelitis often causes trophic disorders, which, in turn, provoke the occurrence of pressure sores in the patient.
The processes of inflammation become stable and decrease through hormonal medications (corticosteroids). Bactericidal and antiviral treatment (antibiotics, sulfonamides, immunostimulating agents) provides accelerated destruction of the infectious agent.
To prevent the occurrence of pressure sores, regular procedures are done to improve trophism and blood circulation: ultraviolet irradiation, dressings with healing ointments, rinsing the skin with potassium permanganate.
When gangrenous lesions appear, therapy provides for surgical intervention (necrotic tissues are excised).
With defects in the functioning of urination, a catheter is placed in the victim. To prevent diseases of the urinary system, regularly washed with an antiseptic. Stimulating agents help the patient to strengthen the degrading muscle tissue. High tonus and muscle contractures in case of spastic paralysis are mitigated by muscle relaxants. Thanks to the use of anticholinesterase drugs, the conduction in nerve stimulation motor neurons improves.
Gymnastics and massage
Careful gymnastics, as well as massage improve muscle, reduce the tension of the apparatus of the ligaments with inflammation of the spinal cord roots. During the recovery period after stabilization of motor defects, the patient is recommended to do exercises to restore the elasticity and mobility of the ligaments.
Reconstructive complex treatment of spinal cord inflammation involves physiotherapy: electrophoresis with biologically active substances and drugs, electrical stimulation in the vertebral region. In addition, balneological procedures (mud treatment, mineral baths) are desirable.
The determination of the prognosis of pathology is influenced by many factors: the condition and age of the patient, the type of disease (secondary or primary, accompanied by other neurological disorders), the occurrence of the inflammatory process and infection. Positive dynamics prevail in general statistics.
Disease prognosis
With inflammation of the spinal cord, its prognosis is determined by the location of the pathology, its shape and severity. As a rule, doctors give a sharply negative prognosis only for the meningococcal type of infection. Other varieties respond to treatment quite effectively.
The recovery process after inflammation of the spinal cord can take a long period. The patient is given a non-working second disability group with medical re-certification every year. It is believed that a complete restoration of lower limb mobility after spinal myelitis is possible literally 6-8 months after the onset of the disease. With a transverse lesion of the spinal cord of a stroke-like character, paraplegia and paralysis are possible. It may also end in absolute recovery.
With a similar frequency, cases are noted that are accompanied by a gradual progression of symptoms, eventually ending in a fatal outcome of the patient for 5-6 years. The most unfavorable prognosis if the inflammatory focus is localized in the lumbosacral region. There is also a certain danger if the cervical spine is affected.
The patient is most likely to recover from myelitis with timely medical attention. When a patient visits a doctor at the stage of loss of sensation in the limbs, the possibility of a full recovery will significantly decrease.
What is called inflammation of the roots of the spinal cord, we now know.
Prevention
Currently, people are vaccinated, which protects them from infectious pathologies that affect the membranes of the brain of the brain and spinal cord:
- polio - infection of the motor function of the vertebral cervical spine;
- measles - a disease whose symptoms are a rash in the mouth and skin, coughing;
- mumps is a virus that affects the salivary glands.
All other causes of the disease are difficult to predict and impossible to prevent. The most important thing is a careful attitude to your own health, if something worries, you need to seek the help of doctors in time and not self-medicate.
We examined the symptoms and treatment of spinal cord inflammation.