Miyelit – the general name for any inflammatory processes of a spinal cord. Symptoms directly depend on level and extent of defeat; most often it is pain (its irradiation), paralyzes, disorder of pelvic functions, violation of sensitivity and other. Diagnostics of a miyelit includes neurologic inspection and assessment of parameters of the cerebrospinal fluid taken on the analysis by a lyumbalny puncture. Also can be appointed KT or MPT of a spinal cord, a miyelografiya. Treatment includes prescription of antibiotics, resolvents, analgetics, miorelaksant, and also LFK, massage and physiotherapeutic procedures.
Miyelit - it is the general name of all inflammations of a spinal cord which can mention both gray, and white substance. That is, miyelity any spinal inflammatory process is called. Depending on a form and prevalence of an inflammation expressiveness of symptoms can differ considerably, but the disease all the same remains rather heavy. Miyelit gives high percent of complications and it is difficult treated. It is difficult to call this disease widespread, it meets no more than in 5 cases on 1 million people.
It is impossible to mark out any features in structure of incidence miyelity, a floor or age practically do not influence risk of development of a disease. Some researchers provide proofs that most often miyelity aged people from 10 to 20 years and the elderly person get sick.
Reasons of development and classification of a miyelit
Sometimes precisely it is not possible to establish the reason of development of a miyelit, but in most cases, the main "starting factors" after all are known. The only classification of a miyelit used in clinical neurology is based on an etiology, that is the cause. According to this classification, allocate three options of a disease: infectious, traumatic and intoksikatsionny.
Infectious miyelit. Makes nearly a half of all cases. This look, in turn, is divided into two groups: primary (in case the infection initially got only into a spinal cord) and secondary (if the inflammation arose after penetration into a spinal cord of an infection from other centers). The reasons of an infectious miyelit most often appear: virus of simple herpes of I and II types, Cytomegaloviral infection, mycoplasmas, syphilis, HIV, enteroviral infections. Slightly less often the meningococcal infection and borelliya can be an etiologichesky factor. Secondary infectious miyelit arises mainly at osteomyelitis of a backbone and at an infection drift with blood.
Traumatic, intoksikatsionny and other types of a miyelit. Intoksikatsionny miyelit arises under the influence of poisons, tropny to cells of a spinal cord. Such inflammation can arise as at sharp poisoning (for example, a number of medicines and psychotropic drugs), and at chronic effect of toxic agent (most often it concerns harmful production).
Miyelit, arisen owing to a spine injury, has two components. First, direct mechanical impact on a spinal cord inevitably leads to violation of its functions. Secondly, when traumatizing microorganisms can get into a spinal cord through a wound. In addition, the spinal inflammation can be caused by some system diseases. Most often it is possible to meet miyelit against the background of multiple sclerosis (in this case miyelit will legally call a symptom of the main disease), a number of autoimmune diseases and a vaskulit. Also miyelit often develops as a component of the paraneoplastic syndrome arising at early stages of growth of a malignant tumor.
Pathogenesis of a miyelit
The provocative factor – whether it be an infection or a trauma – causes hypostasis of a spinal cord. It can be considered a starting point with which all pathological process begins. Hypostasis breaks blood circulation in fabrics, there are vascular blood clots. It, in turn, increases hypostasis. The mechanism of development of a miyelit goes on the so-called "vicious circle" so characteristic of a set of neurologic diseases. Disorder of blood circulation (or even its termination in certain sites) eventually becomes the reason of a softening and a necrosis of tissues of spinal cord.
After recovery the place of a necrosis is filled with connecting fabric – the hem is formed. Certainly, fabric of a hem cannot perform functions inherent in nervous cages therefore many violations which arose during a disease can remain also after recovery. Patomorfologicheski substance of a spinal cord looks edematous, flabby; characteristic "butterfly" has indistinct outlines. At microscopy sites of hemorrhage, hypostasis, disintegration of a myelin, infiltrative process are found.
Symptoms of a miyelit
The clinical picture of a miyelit entirely depends on the place of localization of an inflammation. Level of defeat determine by segments or departments of a spinal cord (in each of which several segments). For example, miyelit can be chest, verkhnesheyny, lumbar etc. As a rule, miyelit covers a segment of a spinal cord on all diameter, breaking work of all conduction systems. It means that both spheres are broken: both motive, and sensitive.
It is worth describing symptoms of a miyelit taking into account time of their emergence. From the moment of an onset of the illness till the heat clinical displays of a disease considerably change. The first signs of an infectious miyelit are not specific at all and a little in what differ from other infectious diseases. The sharp beginning, sharp temperature increase of a body to 38-39C, a fever, weakness – all "standard" signs of any inflammatory process. Further the disease begins to gain lines, characteristic of it. Back pain becomes the first neurologic symptom usually. It can be very intensive (it individually). Pain at a miyelita is not localized in one area: pain extends also to the next parts of the body. Its irradiation (actually, distribution of pain) – a sign of defeat of backs of a spinal cord (radiculitis). Pain can "give" to a back, area of a crotch, hip etc. Everything depends on defeat level. Symptoms become more expressed over time, and in certain cases such "evolution of symptoms" can happen in several hours or days.
As it was already told, the clinic of a miyelit differs depending on inflammation level. Miyelit the top segments of cervical department of a spinal cord it is characterized by spastic tetraparesis. It is most dangerous: always there is a probability of injury of a diafragmalny nerve. It, in turn, threatens with respiratory standstill. Distribution of an inflammation from verkhnesheyny segments up on structures of a medulla can lead to bulbarny frustration. Miyelit at the level of a cervical thickening it is shown by a combination of sluggish paresis of hands to spastic paresis of legs. The lower segments of cervical department are surprised more often than top, and their inflammation is not so dangerous. In some cases it threatens with permanent motive violations (dangers to life miyelit this localization, as a rule, does not bear).
The chest department of a spinal cord suffers, perhaps, most often. Damage to this area is caused by development of spastic paralysis of legs. The last represents paralysis tension. Muscles at the same time get an excessive tone, spasms can develop. The response to check of knee and Achilles reflexes at a chest miyelit always too active. It is worth remembering that at quickly developed cross miyelit at first the lowered tone of muscles can be observed, then, after a while, frustration gain the nature of spastic paralysis.
The lumbar and sacral department of a spinal cord also often is surprised miyelity. The symptomatology of a miyelit of this localization includes peripheral paresis in legs and disorder of pelvic functions as an incontience of urine and a calla. In parallel with it muscles which are innervated by the affected nerves deprived of normal regulation and food, gradually atrophy.
Violations of sensitivity are observed at any option of a miyelit. Only firm rule: frustration of this sort always arise below the place of defeat. Sensitive violations consist in decrease or total absence of painful sensitivity, the lowered reaction to a touch, cold etc. There can be paresteziya – "nonexistent feelings", for example, "goosebumps", cold or feeling of wind.
Diagnostics of a miyelit
There are no nontraumatic methods of diagnostics of a miyelit (certainly if it is necessary to establish the exact reason, but not the preliminary diagnosis). The fullest information is given by a lyumbalny puncture. At sharp process appoint KT or MPT of a backbone and a miyelografiya.
As a rule, given the anamnesis, knowledge of symptoms and results of the analysis of cerebrospinal fluid happens quite enough for faultless diagnosis. The Likvorny puncture also gives the chance to carry out differential diagnostics, that is to specify the diagnosis, having compared the obtained data with symptoms of diseases, similar on clinic. Miyelit it is necessary to differentiate with a syndrome to Giyena-Barra, gematomiyeliy, epidurity, tumors and sharp violation of blood circulation of a spinal cord.
Treatment of a miyelit
At the treatment choice the neurologist has to be guided by information on the possible cause of a disease and features of development of a miyelit in this patient. In all cases at a miyelita antibiotics of a broad spectrum of activity (usually it is necessary to accept antibiotics high doses), resolvents (almost always – glucocorticoids), analgetics, febrifugal medicines are appointed. As necessary (making a start from a condition of the patient) miorelaksant and uroseptik can be appointed. At a delay of urine apply antikholinesterazny medicines, a kateterization of a bladder and its washing by antiseptics.
Huge value in treatment of a miyelit and its consequences the physiotherapy exercises (in the period of a bed rest – in a bed, and later – in the hall or chamber) have, massage (percussion) and physiotherapy. For restoration of function of the damaged nervous cages (as far as it is possible) obligatory use of vitamin medicines (group B). It is desirable that it were injection means. For the purpose of the prevention of decubituses under a sacrum and other bone ledges enclose various devices (wadded tampons, a circle), change position of a body, wipe skin with camphor alcohol or soap and alcohol solution. With the same purpose appoint Ural federal district to sacral and buttock and talocrural area.
Prevention and forecast of a miyelit
The forecast at a miyelita, besides, depends on level and extent of defeat. Verkhnesheyny miyelit becomes frequent a cause of death of patients; lumbar and chest (without timely treatment) with a high share of probability can lead to an invalidization. At a favorable course of disease recovery occurs in 2-3 months, and a complete recovery – in 1-2 years. During this period it is recommended: sanatorium treatment (if it is appointed competently, then duration of restoration will noticeably be reduced), vitamin therapy, prevention of decubituses, physiotherapeutic procedures (Ural federal district), physiotherapy exercises, purpose of antikholinesterazny medicines.
Taking into account quantity of causal factors of development of a miyelit, specific prevention of this disease cannot be by definition. To some extent a disease vaccination helps to warn. It is possible to refer timely elimination of the chronic centers of an infection in an organism to nonspecific prevention of a miyelit (for example, antritis or caries).