What Are Different Types of Encephalomyelitis?

Myelitis is caused by infections of viruses, bacteria, Borrelia, Rickettsia, parasites, protozoa, mycoplasma and other pathogenic infections, or inflammatory lesions of gray matter (and) white matter caused by infection.The following limbs are paralyzed and sensory disorders And autonomic dysfunction are its clinical features. Common myelitis includes purulent myelitis, acute myelitis, acute disseminated encephalomyelitis, subacute necrotizing myelitis, acute necrotizing hemorrhagic encephalomyelitis, acute disseminated encephalomyelitis in children, tuberculous myelitis, etc. .

Basic Information

Visiting department

Neurology

Common causes

Viral, Bacterial, Borrelia, Rickettsia, Parasite, Protozoa, Mycoplasma and other pathogens

Common symptoms

Progressive spinal cord sensory, motor, and autonomic dysfunction

Causes of myelitis

Myelitis mostly occurs after infection, such as virus, bacteria, Borrelia, Rickettsia, parasites, protozoa, mycoplasma and other pathogens. Myelitis is mostly an autoimmune reaction caused by viral infection, and the etiology is not clear.

Clinical manifestations of myelitis

1. Purulent myelitis occurs in young adults. Due to the different parts of the spinal cord invasion, neck pain, chest and back pain, and sensation of girdle, numbness, weakness, and dryness of both lower extremities. More than a few hours or 2 to 3 days, the condition reaches its peak, and when the paralysis reaches its peak, the pain symptoms are not obvious; if it is transverse spinal cord injury, the acute stage is represented by spinal shock; if it is ascending myelitis, swallowing may occur Difficulty, articulation, paralysis of the respiratory muscles and even death.
2. The clinical manifestations of acute myelitis are acute onset. At the time of onset, there may be low fever, nerve root pain in the affected area, limb numbness, and a sense of banding in the diseased segment; paralysis may occur without any other symptoms. Dyskinesia, loss of sensation, and bladder and rectal sphincter dysfunction usually occur within hours or days. The dyskinesia is manifested by spinal shock in the early stage. Generally, it lasts for 2 to 4 weeks, muscle tension gradually increases, tendon reflexes become active, Pathological reflex.
The length of spinal shock depends on the severity of spinal cord injury and the presence of complications such as pulmonary infection, urinary tract infection, and pressure ulcers. When a spinal cord injury is severe, it often leads to an increase in flexor muscle tension, and stimulation of any part of the lower limbs or bladder filling can cause flexion reflexes and spasms of the lower limbs, accompanied by symptoms such as sweating, vertical hair, and automatic discharge of urine. Often prompts a poor prognosis. With the recovery of the disease, the sensory level gradually decreases, but it is slower and worse than the recovery of motor function. Autonomic nerve dysfunction is manifested as retention of stool in the early stage, and then with the recovery of spinal cord function, a reflex neurogenic bladder can be formed.
3. The majority of cases of acute disseminated encephalomyelitis are children and young adults. The onset of acute onset is 1 to 2 weeks after infection or vaccination. Most of them are sporadic, non-seasonal, and serious. Some cases are dangerous and common in some cases. Two to four days after the rash, patients often experience high fever, seizures, lethargy, and deep coma when the rash spots are receding and the symptoms improve.
The first symptoms of encephalitis are headache, fever, and blurred consciousness. In severe cases, coma and denervation may occur quickly. Seizures may occur. Meningeal involvement may cause headache, vomiting and meningeal irritation. Myelitis type common partial or complete flaccid paraplegia or quadriplegia, conduction beam type or lower limb sensory disorders, pathological signs and urinary retention. Visible nerve signs of the optic nerve, hemisphere, brainstem, or cerebellum are involved. Pain in the midline of the back may be a prominent symptom.
4. Most patients with subacute necrotizing myelitis are men over 50 years of age. The clinical manifestations are progressive spinal radiculitis. About half may have acute pain and sensory disturbances, or intermittent sciatica. It can also be manifested as a more complete spinal cord injury, or transient weakness and sensory impairment, followed by progressive spinal nerve root symptoms. There may still be sphincter dysfunction.
5. Tuberculous myelitis is more common in young adults, and there may be a history of tuberculosis exposure or history of tuberculosis before the disease. Onset is usually slow, with fever, poor appetite, weight loss, night sweats, etc. at the same time as symptoms of the spinal cord. Spinal cord injury is often incomplete, with paralysis, sensory impairment, and dysfunction of the stool below the lesion level. When the lesions are mainly meningeal and spinal arachnoid lesions, neural root pain is the main manifestation, and there are dispersive, asymmetric, and segmental sensory disorders. The clinical manifestations are similar to spinal arachnoiditis.

Myelitis examination

1. Blood routine examination.
2. Cerebrospinal fluid examination.
3. Etiological basis.
4. Chest X-ray examination, magnetic resonance examination, CT examination.

Myelitis diagnosis

1. Progressive spinal cord sensory, motor, and autonomic dysfunction;
2. bilateral symptoms or signs (not necessarily symmetrical);
3. Clear sensory plane;
4. Except compression imaging lesions (MRI or myelography; if conditions do not have a feasible CT examination);
5. Suggests the manifestation of spinal cord inflammation, increased cerebrospinal fluid lymphocytes, increased IgG synthesis rate, or enhanced scans; if there is no such manifestation in the early stage, MRI and lumbar puncture can be reviewed on days 2-7;
6. Peak within 4 hours to 21 days after onset.

Myelitis treatment

1. General treatment Acute bed should rest in bed and be given a diet rich in calories and vitamins. Or give ATP, coenzyme A, adenosine, citicoline and other drugs to promote the recovery of nerve function. A small amount of multiple infusions of fresh plasma from healthy people can also help improve the patient's immune function and help prevent infection and recover.
Turn over frequently, keep the skin clean and dry, and pay attention to massage the pressured part to prevent the occurrence of pressure ulcers.
For severe urinary retention, urinary catheterization is needed, and a sterile urinary catheter can be placed, and urine is released every 3 to 4 hours to prevent bladder contracture. Care should be taken to prevent urinary tract infections during indwelling catheterization. For those who have difficulty in defecation, they should clean the enema or choose laxatives in time.
2. Different treatments for different myelitis treatments. Generally it is anti-infective treatment and immunotherapy.

Myelitis prognosis

The prognosis depends on the degree of acute myelitis damage, the extent of the lesion, and the complications. If there are no serious complications, basically recover within 3 to 6 months. Six months after complete paraplegia, the electromyogram is still denervated, MRI shows extensive intramedullary signal changes, lesions involving many spinal cord segments, and diffuse prognosis. Patients with urinary tract infections, pressure ulcers, and lung infections often affect recovery and have sequelae. Acute ascending myelitis and high cervical myelitis have a poor prognosis and can die from respiratory failure in the short term.