What Is Transverse Myelitis?

Also known as acute non-specific myelitis, acute myelitis, acute ascending myelitis, etc., is sometimes also considered to be an acute non-suppurative inflammatory disease of the spinal cord, which often causes transectional damage to the spinal cord, leading to limbs below the lesion level Paralysis, various sensory deficits, and bladder and rectal autonomic dysfunction are among the common diseases of clinical neurology.

Transmyelitis

Transverse myelitis is non-conducting. The spinal cord dysfunction caused by unexplained infection directly or induced by infection leads to nerve impulse block in all or most of the nerve bundles. It is limited to a few segments of acute transection. Spinal cord inflammation. Most develop symptoms after acute infection or vaccination. Manifestations include paralysis of the spinal cord below the level of spinal cord disease, sensory loss, and bladder, rectal, and autonomic dysfunction. Is one of the common spinal diseases. The disease can be seen in any season, but it is more noticeable in late winter and early spring and late autumn and early winter.

Overview of Transmyelitis Disease

Causes of Transverse Myelitis Disease

It is not clear. It is generally believed that the disease is an autoimmune response caused by a viral infection in the mental system or after vaccination. Whether it is a direct invasion of the virus needs further study. Trauma and excessive fatigue can be incentives.

Clinical manifestations of transmyelitis

More common in young adults, no gender differences. Scattered onset, sudden onset, fever, general discomfort, symptoms of upper respiratory tract infection or history of diarrhea, or history of vaccination, 1-2 weeks before the onset of spinal cord symptoms, often with cold, weight, injury and other causes.

Sudden spinal symptoms appear. Patients initially experience local cervical and back pain or abdominal pain, and chest and abdomen sensations such as nerve root irritation, and then suddenly numbness in the lower limbs, weakness, loss of sensation, and defecation disorders. Most patients reach their peak within hours or 1-2 days and develop complete transection of the spinal cord.

Sensation of dullness can arise from the feet and rise symmetrically or asymmetrically, with one leg earlier than the other. These symptoms may begin to resemble Guillain-Barre syndrome, but the apparent spinal plane of the trunk involvement suggests the nature of myelopathy.

In the acute stage, there are many sensory deficits below the diseased segment. Some patients may have 1 or 2 sensory hypersensitive regions on the upper edge of the sensory loss region. A small number of patients with mild spinal cord injury or pediatric patients may not have obvious sensory levels. It can damage any segment of the spinal cord, but the most common is 3-4 segments of the thorax. Symptoms depend on the damaged segment. Thoracic lesions occur with spinal dysfunction below the level of thoracic lesions.

In severe cases, the disappearance of reflexes indicates the occurrence of spinal cord shock. Patients often show delayed limb paralysis, that is, reduced muscle tone, weakened or disappeared key reflexes, negative pathological reflexes, and disappearance of abdomen and cremaster reflexes, that is, spinal shock. With the recovery of the spinal cord shock phase, the paralyzed limbs show an extensional reflex. After the pathological reflex is positive, the key reflex gradually increases, and the muscle strength begins to recover. Persistent non-reflective paralysis suggests multiple segments of necrosis of the spinal cord. Sphincter dysfunction is mainly urinary retention in the early stages, and there may be full incontinence. With the gradual recovery of spinal cord function, reflex neurogenic bladder and intermittent urinary incontinence can be formed.

Transmyelitis dyskinesia

In early cases of acute cases, spinal shock is present: all movements, sensations, and reflexes below the lesion level disappear, there is no response to any stimulus, and paralyzed limb muscle tension decreases. The duration of the spinal shock period is usually 3-4 weeks, there are as few as a few days or as long as 1-2 months, or even longer. The length of the shock period depends on the degree and nature of spinal cord injury and the presence of complications such as urinary tract infections and bedsores.

Transmyelitis sensory disorder

Below the damaged plane, a conduction beam type sensory disorder appeared, and all sensations disappeared, with pain and temperature sensations disappearing most. Some patients feel the upper edge of the disappeared area, but may have an allergic area. Occasional girdle-like pain.

Transmyelitis bladder dysfunction

During spinal shock, detrusor muscles relax, bladder capacity increases, and there is a tension-free neurogenic bladder. The patient developed urinary retention or overflow urinary incontinence. With the recovery of spinal cord function, the detrusor muscles contracted rhythmically, and the bladder capacity gradually decreased, gradually transitioning to a reflex neurogenic bladder. The patient gradually regained the ability to urinate at will.

Transmyelitis rectal dysfunction

Anal sphincter relaxation during spinal shock, and recovery from fecal incontinence, often with constipation, will gradually return to normal afterwards.

Autonomic dysfunction of transverse myelitis

Below the level of damage, little or no sweat, skin nutritional disorders. Such as edema or desquamation, crisp nails, cleft palate, etc.

Those with lesions in the cervical spine had quadriplegia. High neck involvement may cause dyspnea due to diaphragmatic dyskinesia. Neck 8-thoracic 1 damage may cause sympathetic nerve paralysis due to sympathetic nerve damage. Lumbar myelitis occurs only with lower limb dysfunction and paralysis. Sacral myelitis, only saddle-like sensation loss, anal reflex and testicular reflex disappeared, no obvious limb movement disorders, bladder function manifested as urinary retention in the early stage, and stress urinary incontinence during recovery.

Manifestations of different segments of transmyelitis

Neck section-quadriplegia

Segments above C4-All limbs are centrally paralyzed, and respiratory muscles are paralyzed

Enlarged neck-flaccid paralysis of both upper limbs and central paralysis of both lower limbs

Thoracic section-Central paralysis of both lower limbs

Lumbar section-slow paralysis of both lower extremities and normal chest and abdomen

Sacral segment-sensory disturbance of perineum, disappearance of anal and cremaster test, without obvious limb movement disorder and pyramidal sign

Diagnosis of Transverse Myelitis

History of Transverse Myelitis:

More common in young adults, scattered onset.

Clinical manifestations of transmyelitis:

Symptoms of infection first followed by acute onset.

Rapidly developing manifestations of spinal cord transection.

Transverse myelitis auxiliary examination:

1) Cerebrospinal fluid examination: normal pressure, colorless and transparent appearance, slightly increased cell number and protein, normal sugar and chloride. Individual acute phase may have vertebra management obstruction.

2) MRI: Swelling of the spinal cord, long T1T2 signal

Differential diagnosis of transmyelitis

(1) It is distinguished from periodic paralysis based on medical history, paraplegia, early occurrence of constipation dysfunction, and unrelated incidence of full meals.

(2) Differentiated from acute infectious polyradiculoneuritis based on precursor symptoms, onset forms, signs of the nervous system, and laboratory tests.

(3) Differentiate from multiple sclerosis based on whether it is accompanied by symptoms of optic nerve or central nerve damage and recurrence.

(4) Differentiate from spinal cord compression such as spinal hemorrhage, spinal tuberculosis, cancer metastasis, and epidural abscess.

Transverse Myelitis Disease Treatment

(1) Hormonal therapy: glucocorticoids can be applied, such as intravenous infusion of hydrocortisone 100-300mg, or dexamethasone 5-10mg, once a day, after 7 consecutive days, change to oral prednisone, and then gradually reduce To stop.

(2) Antibiotics: to treat existing infections or to prevent infections.

(3) Vitamins: can accelerate the regeneration of peripheral nerves. Such as vitamin B1, vitamin B6, vitamin B12 and so on.

(4) Energy mixture and vasodilator: the purpose is to nourish nerves. Coenzyme A, adenosine triphosphate, dibazole and the like are available.

(5) Those who have difficulty breathing should keep the airway open and give oxygen inhalation. If there is secretion accumulation or weak sputum, tracheotomy can be performed, and artificial respirator is used if necessary.

(6) Pay attention to prevent lung infection and acid-base balance imbalance.

Transverse Myelitis Disease Care

(1) Prevention of skin care and bedsores:

Keep the skin clean and dry, and wash it immediately after the urine is polluted. When changing bed sheets and performing all nursing operations (including turning over, changing diapers, placing and placing potty, etc.), the movements should be gentle and slow. It is strictly forbidden to drag, pull, or stopper hard to prevent skin damage.

Keep the bed unit clean, dry and level without slag. Sponges can be placed under the sheets to make the beds soft.

According to the skin condition of the patient, turn over every 1-2 hours to avoid long-term compression in some parts. After turning over, check the compressed area and massage in parallel to help improve blood circulation.

Cotton pads and cotton laps can be placed on the patient's zygomatic tail, hip, inner and outer ankle, heel and other bone bulges to protect them.

If the skin pressure is not easy to fade, you can use 50% safflower alcohol to massage locally and increase the number of turns. For existing bedsores, if the wound is superficial, you can use infrared or ultraviolet light to irradiate the local area 1-2 times a day and apply gentian purple. Applying dual-throat wind spray to the affected area is more effective in keeping the wound dry and promoting wound healing. For severe bedsores with necrotic tissue, debridement and dressing are feasible.

Do not use hot water bottles, hot packs or other heating appliances below the damaged surface to prevent skin burns.

(2) Nursing of urination and defecation disorders:

For patients with urinary retention, urethral catheterization should be performed in time, and urine should be released every 4 hours. When inserting a urinary tube, the principles of aseptic technique must be strictly implemented. Wash and disinfect the urethral orifice twice daily with 0.1% Xinjieer. A closed bladder irrigation device was used to flush the bladder twice with 250 ml of 0.02% furancillin daily. Drainage bags and tubes should be changed daily to prevent urinary tract infections.

Patients with spinal cord shock often have fecal incontinence. They should wash their hips with warm water in time and apply hip oil to prevent flushing.

Patients in the recovery period often have constipation. They can take drugs such as senna, Guodao, Ma Ren Run Chang Wan pills, or use Kaisailu, if necessary, enema. Patients with bloating can perform abdominal massage or ventilate the anal canal.

(3) Pay attention to changes in the condition to prevent lung infections:

Pay attention to observe the patient's breathing and whether the sensory level is rising. If the patient feels belching, chest tightness or flat rise, they should report to the doctor in time and give corresponding treatment such as oxygen inhalation.

Prepare rescue equipment and medicines such as ventilator, sputum suction device, tracheotomy materials, etc., and reserve them.

For patients who have difficulty breathing, if tracheotomy is performed, care should be taken after tracheotomy. Sputum should be sucked in time to keep the airway open.

In order to improve alveolar ventilation and prevent fallout pneumonia, patients should be frequently assisted to change their position, pat their backs, and encourage patients to sputum. Patients can be assisted several times a day.

Long-term use of large amounts of hormones can easily reduce the patient's resistance. Keep warm and avoid cold.

(4) Diet care: high-calorie, high-protein, high-vitamin, low-fat, low-residue foods should be consumed. To prevent decalcification of long bones, eat more acidic foods and vegetables. Ensuring sufficient water and encouraging more water can help prevent urinary tract infections.

(5) Pay attention to maintaining the functional position of the limbs. The quilt should not be too heavy. Paralyzed limbs can be maintained with a stent to keep the hips and knees in the abduction and extension positions to prevent sagging of the feet and contracture and rigidity of the lower limb joint deformities.

(6) Do a good job of patient psychological care: due to the acute onset of myelitis patients, sudden paralysis and mental dysfunction, patients often think too much about the prognosis of the disease and how to arrange work, life and learning in the future. Anxiety, anxiety, depression, fear and even pessimistic psychological reactions appear. At this time, the nurse should pay attention to the psychological care of the patient, talk more with the patient, pay attention to the mild language, attitude and kindness, explain to the patient the effect of maintaining a comfortable mood on the prognosis of the disease, encourage the patient to strengthen the confidence to overcome the disease, and actively cooperate with the doctor and nurse Perform various treatments and care. Encourage patients to engage in active exercise early. Pay more attention to patients in life, and do every life care carefully, so that patients can maintain the best state of mind when receiving treatment.

(7) Nursing during recovery period: The paralyzed limbs should be passively exercised and massaged as soon as possible. When the paralyzed function is recovered, the patient is encouraged to actively take the initiative to exercise.

(8) Prognosis: Those with a history of colds and fever before the onset of the disease, those with only 1-2 segmental spinal cord transection, and those who use hormone therapy properly without complications, generally have a good prognosis, and most can resume walking.