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 the nervous tissue. Depending on the width of the lesion and localization, the disease can interrupt the connection of the body with the brain or permanently disrupt the control of the limbs and the functioning of internal organs.
Reasons for appearance
Varieties of myelitis are divided into two main groups, which are formed on the basis of the sequence of appearance of the lesion process:
- Primary. Pathology is the result of a direct lesion (infection, injury) of the patient's spinal cord.
- Secondaries. The disease develops against the background of another disease or is its complication (that is, a consequence of a secondaryinfection).
There is simultaneous inflammation of the brain and spinal cord.
Classification
There is a classification according to the mechanism of the inflammation process. Depending on this, myelitis is divided into the following categories:
- traumatic;
- infectious;
- idiopathic (etiology unclear);
- intoxication.
Infections of an infectious nature are produced mainly by the hematogenous method, through the blood supply system (the only exception is infection in 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 probable causative agents of infectious primary myelitis are neurotropic (having the ability to penetrate into neurons) viruses of tetanus, influenza, measles, chicken pox, rabies, mumps, lichen, poliomyelitis, various types of herpes (cytomegalovirus, herpes simplex, Epstein-Barr). How else does spinal cord inflammation occur?
Provoking factors of secondary infection
Focuses of infection of a secondary type 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:
- percinous anemia (neuronal death, demyelination, lack of vitamin B12); diabetes mellitus;
- 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 for intervention on the spine), collagenoses (connective tissue diseases), heavy metals, inflammation of the meninges (arachnoiditis), autoimmune diseases.
Inflammation of the spinal cord can be caused by the introduction of a vaccine for any of the above viral diseases.
Development Features
Infection enters the spinal cord from the outside either by hematogenous or lymphogenous way from the primary focus (with lymph or blood). Myelin sheaths or nerve fibers of the spinal cord become the second way of introduction.
First, the space between and under the membranes is infected, 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 from a specific muscle group or internal organ to the brain of the head and back. Myelitis depending on the number of infected segmentsdefined as limited (localized), segmented (disseminated) or focal (in unrelated or adjacent segments). Opticomyelitis is isolated separately when transverse myelitis and optic neuritis are combined, which is characterized by demyelination.
By localization
By localization in the brainstem, myelitis is divided into:
- transverse (the affected area is the white and gray matter of the brain in a number of segments at once);
- anterior (affected area - white matter in the zone of the median anterior sulcus);
- peripheral (white matter of the brain is affected on the sides and back);
- central (grey matter 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.
By intensity
Disease according to the intensity of the reaction is defined as:
- Acute, which develops quickly, deep tissue damage, there may be several foci of development.
- Subacute. Slowly developing, accompanied by pain 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 diseases: the first type of T-lymphotropic virus and HIV infection.
The main result of the activity of immune cells is neuronal degeneration and demyelination of the closest conducting nerves, whichinvolved in the process of inflammation. Necrotization of nerve tissues is manifested as 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, blurred border between white and gray matter (seen on MRI). If it is greatly increased, then blood clots in the capillaries, microscopic hemorrhages, destruction of cell walls, and disintegration of the neuronal myelin sheath are noticeable.
The disease more often (about 40% of cases) affects the thoracic spine and the lower part of the spinal column. In terms of frequency of infection, the second is the upper half of the chest, lower back and thoracic-lumbar junction. The neck is rarely infected. More often adjacent pairs of vertebrae or several departments are affected (disseminated inflammation).
Symptoms and treatment of spinal cord inflammation are interrelated.
Symptoms
Myelitis symptoms vary clinically. 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 inflammation of the spinal cord are similar to signs of any infectious process: general weakness, chills, fever up to 39˚. The presence of neurological pathology is indicated by back pain that can spread to neighboring tissues from the affected area.
Strongly developed inflammation of the substance of the spinal cord leads to loss of sensitive andmotor function.
Diagnostic features
The infectious origin of acute myelitis can be recognized by characteristic features, her neurological tests confirm. Imaging diagnostic methods can be used to identify less severe chronic and subacute forms.
Computed tomography using a contrast agent or magnetic resonance imaging are the leading imaging methods. In addition, myelography (a less effective type of fluoroscopy) is used.
How is the pathogen identified?
The infectious agent is determined by bacteriological analysis 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.
Tests and symptoms may indicate diseases similar in their mechanism of development: malignant tumors, multiple sclerosis, epiduritis (epidural purulent abscess), arachnoiditis, polyneuropathy, encephalomyelitis. With the help of differential diagnosis, the diagnosis is specified.
Treatment
It is desirable to treat inflammation of the spinal cord in stationary 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 violationstrophics, which, in turn, provoke the occurrence of bedsores in the patient.
Inflammatory processes are stabilized and reduced by hormonal medications (corticosteroids). Bactericidal and antiviral treatment (antibiotics, sulfonamides, immunostimulants) provides accelerated destruction of the infectious agent.
To prevent the appearance of bedsores, regular procedures are done to improve trophism and blood circulation: ultraviolet irradiation, dressings with healing ointments, washing the skin with potassium permanganate.
When gangrenous lesions appear, therapy involves surgery (necrotic tissue is excised).
In case of defects in the functioning of urination, a catheter is put in the victim. To prevent diseases of the urinary system, regular rinsing with an antiseptic is performed. Stimulants help the patient to strengthen the degrading muscle tissue. High tone and muscle contractures in spastic-type paralysis are alleviated by muscle relaxants. Through the use of anticholinesterase drugs, conductivity in the motor neurons of nerve excitation improves.
Gymnastics and massage
Careful gymnastics, as well as massage, improve muscles, reduce the tension of the ligament apparatus in case of inflammation of the roots of the spinal cord. During the recovery period after stabilization of motor defects, the patient is advised to do exercises to restore elasticity and mobility of the ligaments.
Restorative complex treatment of inflammation of the spinal cord involves physiotherapy: electrophoresis with biologically active substances and drugs, electrical stimulation in the spinal region. In addition, balneological procedures (treatment with mud, mineral baths) are desirable.
Many factors influence the determination of the prognosis of pathology: the condition and age of the patient, the type of disease (secondary or primary, accompanied by other neurological disorders), the occurrence of an inflammatory process and infection. Positive dynamics prevails in the overall statistics.
Disease prognosis
With inflammation of the spinal cord, its prognosis is determined by the location of the pathology, its form and the severity of the course. As a rule, doctors give a sharply negative prognosis only with the meningococcal type of infection. Other varieties can be treated 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 recertification every year. It is believed that it is possible to fully restore the mobility of the lower extremities after myelitis of the spinal cord literally 6-8 months after the onset of the disease. With a transverse lesion of the spinal cord of a stroke-like nature, paraplegia and paralysis may persist. It may also end in absolute recovery.
With a similar frequency, there are cases that are accompanied bygradual progression of symptoms, eventually ending in the death of the patient for 5-6 years. The most unfavorable prognosis is if the inflammatory focus is localized in the lumbosacral region. There is also a certain danger if the cervical region is affected.
The highest probability of a patient's recovery after myelitis is observed with timely medical care. When a patient contacts a doctor at the stage of loss of sensation in the limbs, the possibility of a complete recovery will significantly decrease.
What is the name of the inflammation of the roots of the spinal cord, now we know.
Prevention
Currently, people are being vaccinated, which protects them from infectious pathologies that affect the membranes of the brain and spinal cord:
- poliomyelitis - infection of the motor function of the spinal cervical region;
- measles is a disease whose symptoms are a rash in the mouth and on the skin, coughing;
- mumps is a virus that affects the salivary glands.
All other causes of the development of the disease are difficult to predict and impossible to prevent. The most important thing is to be attentive to your own he alth, if something bothers you, you need to seek help from doctors in time and not self-medicate.
We looked at the symptoms and treatment of spinal cord inflammation.
