Acute myelitis is a non-specific inflammatory lesion of the spinal cord, which is more common in young adults. The disease starts rapidly and spreads from the lower extremities to the upper extremities or the innervated muscles of the medulla oblongata, resulting in dysphagia, dysarthria, respiratory muscle paralysis, and even death.
1. Etiology
The cause is unknown, but it may be due to some viral infections or an autoimmune reaction of the body after infection, and some occur after vaccination. It is common in young adults. There may be a history of fever, general malaise or upper respiratory tract infection a few days or 1 to 2 weeks before the disease. The onset of the disease is rapid, often starting with back pain or a feeling of thoracic and lumbar girdle, followed by symptoms such as numbness and weakness, which mostly develop to a peak within a few hours to a few days, with symptoms of transverse spinal cord damage.
2.Diagnosis
The diagnosis is based on the acute onset of the disease, which rapidly progresses to complete transverse or disseminated damage to the spinal cord, often involving the thoracic medulla. Motor, sensory and autonomic dysfunction below the level of the lesion. Combined with cerebrospinal fluid and MRI examination can confirm the diagnosis.
3.Differential diagnosis
Differentiation from the following diseases causing acute limb paralysis is required.
(1) Acute epidural abscess: Acute transverse spinal cord damage may occur, and the disease is often preceded by septic infection in other parts of the body, and the pathogenic bacteria spread to the epidural area via bloodstream or adjacent tissues to form an abscess. Sudden onset of disease several days or weeks after the primary infection, with symptoms of infection toxicity such as headache, fever, and peripheral weakness, often accompanied by radicular pain and spinal tap pain. Peripheral blood leukocyte count is increased; spinal canal obstruction, CSF cell count and protein content are significantly increased; CT and MRI are helpful for diagnosis.
(2) Spinal tuberculosis or metastatic tumor: both can cause bone destruction and collapse of the vertebral body and acute transverse damage by compression of the spinal cord. Tuberculosis of the spine often has systemic toxic symptoms such as hypothermia, poor nausea, wasting, atrophy, weakness and other tuberculous lesions, and the lesion spine spine is obviously protruding or posteriorly convex into an angular deformity, and the spine X-ray shows typical changes such as destruction of the vertebral body, narrowing of the intervertebral space and shadow of paravertebral cold abscess. Specialized tumors are common in the elderly, and vertebral destruction is visible on X-ray, and the diagnosis can be confirmed if the primary lesion is found.
(3) Spinal cord hemorrhage: caused by spinal cord trauma or vascular malformation. The onset is acute, with rapid onset of severe back pain, paraplegia and sphincter dysfunction. Lumbar puncture CSF is bloody, spinal cord CT shows high density shadow at the site of hemorrhage, and spinal cord DSA can find spinal cord vascular malformation.
4.Treatment
There is no specific treatment for this disease, which mainly includes reducing spinal cord damage, preventing and controlling complications and promoting functional recovery.
Drug treatment.
(1) corticosteroids, high-dose methylprednisolone.
(2) immunoglobulins, such as gammaglobulin.
(3) Antibiotics.
(4) B vitamins for neurological recovery.
Additional treatment.
(1) More exercise.
(2) Getting enough sleep every day.
(3) To have adequate nutrition.
(4) To keep yourself at the right amount of temperature.