Overview.
Purulent myelitis (PM) originates primarily from systemic or localized infections. Bacteria enter the spinal cord via the blood
The bacteria enter the spinal cord through the bloodstream or by direct carriage, with Staphylococcus aureus infection being the most common, and the thoracic medulla being the most commonly involved.
Infection with S. aureus is the most common, with the thoracic medulla being the most commonly involved, manifesting as partial or complete transverse inflammatory damage to the spinal cord. The spinal cord becomes congested and swollen in the early stage of inflammatory reaction.
Later, the spinal cord becomes purplish gray, soft, and necrotic. It is a disease with stage, ascending and transverse characteristics, mainly damaging the spinal cord nerves, which will bring great pain or even lifelong disability if not treated in time or delayed treatment.
Causes
1. Infection of adjacent tissues of the spinal cord, such as open infected wounds caused by spinal gunshot wounds.
2. Blood-borne infections, such as acute spinal cord inflammation caused by thoracic infection, periodontal abscess, purulent meningitis, and so on.
Inflammation.
3. Medical infections, less frequently, due to neurosurgery, and in rare cases caused by invasive diagnostic manipulation of the central nervous system.
A few cases are caused by invasive diagnostic and therapeutic operations in the central nervous system.
Symptoms
The disease is most common in young adults. Because of the different parts of the spinal cord invasion can be manifested as neck pain, chest and back pain and girdle feeling, numbness of both lower limbs,
weakness, dryness and so on. The condition reaches its peak in a few hours or two to three days, and when the paralysis reaches its peak, the pain becomes less obvious.
When the paralysis reaches its peak, the pain is not obvious; in the case of transverse spinal cord damage, the acute phase is characterized by spinal shock; in the case of ascending spondylitis, dysphagia may occur.
In case of transverse spinal cord damage, the acute stage is characterized by spinal shock; in case of ascending spinal cord inflammation, dysphagia, dysarthria, respiratory muscle paralysis and even death may occur.
1. The disease mostly involves the thoracic spinal cord. At the beginning, there are chills and high fever, and radicular pain, which rapidly develops into paraplegia, usually reaching the symptomatic stage within a few days.
Usually, the peak of symptoms is reached within a few days, and there is a complete lack of sensation below the level of damage, accompanied by sphincter obstruction, spinal membrane and spinal nerve paralysis.
Sensory loss below the level of damage is complete, with sphincter obstruction, and irritation of the spinal membrane and spinal nerve roots is obvious.
2. Motor and sensory abnormalities. If the thoracic spinal cord is involved, there may be a feeling of girdle in the chest, abdomen and back, numbness or loss of sensation below the damage level, and weakness or paralysis of both lower limbs. If the cervical cord is involved, there may be upper limb muscle weakness, gradual atrophy of hand muscles if the disease is not cured, decreased or loss of pain and temperature sensation.
If the cervical medulla is involved, there may be muscle weakness in the upper limbs, gradual atrophy of the muscles of the hands if the disease does not get better, and loss of pain and temperature sensation. In severe cases, the lower limbs have abnormal movement and sensation, even resulting in paralysis.
In severe cases, the lower limbs have abnormal movement and sensation, and even cause paralysis.
3. Sympathetic nerve symptoms. Dry skin and abnormal sweating of the limbs.
4. Breathing disorders. Weakness and difficulty in inhalation and exhalation.
Examination
1.Acute phase peripheral blood picture white blood cell (WBC) count is significantly increased, mainly neutrophils, may appear immature
Mature cells may be present.
2. Bacterial culture of blood may show growth of staphylococcus or other infectious bacteria.
3. Lumbar puncture, usually the cerebrospinal fluid is turbid in appearance, with increased white blood cell count, mainly neutrophils, elevated protein levels, glucose or chloride.
The amount of protein is elevated, and the glucose or chloride level is lowered.
4. X-ray radiography shows localized abscess; MRI of the spinal cord shows swelling of the spinal cord at the lesion, low signal at T1, high signal at T2, or mixed signals.
Diagnosis
The disease can basically be judged based on clinical symptoms, blood tests, cerebrospinal fluid examination, and imaging examinations. Blood bacterial culture can determine the pathogenic bacteria.
Differential diagnosis
1. Tuberculous myelitis
The main pathogen is Mycobacterium tuberculosis. Involvement of thoracolumbar spinal cord is more common. Single or multiple tuberculous granulomas or tuberculous balls can be seen in the spinal cord.
The spinal cord can be characterized by single or multiple tuberculous granulomas or tuberculous balls, or thickening of the spinal membrane and nerve roots. The disease can be identified by cerebrospinal fluid, CT, and X-ray
The tumor can be identified by cerebrospinal fluid, CT scan, and X-ray examination.
2. Spinal cord tumors
Ventricular meningiomas, astrocytomas, and hemangioblastomas are common. They can be identified by X-ray, CT examination and MRI scan.
MRI scan.
3. Spinal trauma
It can be identified by X-ray and CT examination.
4. Acute epidural abscess
Often forms 3-4 weeks after acute bacterial infection. There is obvious and severe radicular pain and obvious spinal tenderness.
Positive lumbar puncture cervical pressure test. It can be identified by spinal CT and MRI.
Treatment
Early hospitalization and timely treatment to prevent complications such as out-of-hospital pressure ulcer formation and urinary tract infection is the key to improve the cure rate.
1. Anti-infection: broad-spectrum antibiotics should be used in combination, and sensitive broad-spectrum antibiotics that can cross the blood-brain barrier should be selected according to drug sensitivity test.
According to the drug sensitivity test, choose sensitive and broad-spectrum antibiotics that can cross the blood-brain barrier.
2. Glucocorticoid drugs should not be used routinely, but can be used as appropriate when the patient has serious infection and spinal cord damage and when effective antibiotics are applied, but these drugs have immunosuppressive effects, leading to a decrease in the body’s resistance to infection.
Decreased resistance to infection. Tuberculosis, diabetes mellitus, gastric ulcer, etc. should be ruled out before medication is administered, and cardiac and renal
The heart, kidney function and electrolyte changes should be understood.
3. Symptomatic supportive therapy, nutritional support is very important, adequate nutritional supply plays an extremely important role in reducing the occurrence of complications and improving the cure rate.
Adequate nutritional supply plays an important role in reducing complications and improving cure rate. Due to the patient’s dysphagia, a dietitian was asked to consult with the patient after admission to the hospital to formulate a reasonable diet plan.
The patient was given a high-protein, high-calorie, easy-to-digest liquid diet, and when necessary, high-calorie diet was fed intravenously.
If necessary, intravenous high nutrients should be given.
4. If necessary, incision and drainage can be performed at the site of the spinal abscess.
Prognosis
If the acute stage can be treated promptly and appropriately, severe disability and death rate can be reduced.
Nursing care
The patient has a long recovery period after discharge from the hospital, and must be taught proper nursing care, methods of exercise, and many precautions.
1. Strengthen the patient’s confidence in future recovery, overcome his dependence and laziness, and formulate a rehabilitation program.
2. Advise patients to drink more water, exercise their abdominal muscles, and train the function of urination and defecation.
3. Pay attention to skin care and prevent pressure sores.
4. Pay attention to the change of climate and prevent colds.
5. Strengthen nutrition, take medication on time, and review regularly.