Spinal cord myelitis restoration of leg mobility

Infectious myelopathy

Viral damage to the spinal cord is accompanied by specific types of myelitis. In the past, the most common spinal cord infection was polio. Currently, the most common cause of viral myelitis is herpes zoster, which initially produces radicular symptoms. The pathological process in herpes zoster affects not only the gray matter of the spinal cord, as in polio. Lymphocytes are always found in the cerebrospinal fluid (CSF, cerebrospinal fluid) of patients.

MRI of the cervical spinal cord in infectious myelitis: c — axial T2-weighted image shows that the spinal cord lesion occupies its central part; d — enhancement of the pattern of the spinal cord lesion on the axial T1-weighted image after administration of a contrast agent.

Intramedullary spinal cord abscesses have been described in systemic spinal cord infections of bacterial and mycobacterial etiology. Chronic lesions of the spinal cord membranes during syphilis can lead to sluggish secondary subpial myelitis and radiculitis. Severe granulomatous, necrotizing and inflammatory myelitis is typical of Schistosoma mansoni infestation. Granulomatous, necrotizing and inflammatory myelitis is caused by a local reaction to tissue-digesting enzymes produced by parasite eggs.

Magnetic resonance imaging (MRI) of the spinal cord for myelitis due to Zika virus infection. A - T2 MRI of the spine showing increased signal in the thoracic region T5-T8 (indicated by arrow) and enlargement of the cervical spinal cord. B, STIR MRI of the spine shows signal enhancement in the cervical spinal cord C4–C7 (arrowed).

Associated disorders

As mentioned above, transverse myelitis can be a relatively rare manifestation of several autoimmune diseases, including systemic lupus erythematosus (SLE), Sjögren's syndrome, and sarcoidosis.

• SLE is an autoimmune disease of unknown cause that affects multiple organs and tissues in the body. SLE can cause transverse myelitis, which may recur periodically.
• Sjögren's disease is another autoimmune disease characterized by invasion and infiltration of the lacrimal and salivary glands by white blood cells, resulting in decreased production of these fluids, causing dry mouth and eyes. Several tests can confirm this diagnosis: the presence of SS-A/SS-B antibodies in the blood, ophthalmological examinations confirming decreased tear production, and the presence of lymphocytic infiltration in biopsy samples of the minor salivary glands (minimally invasive procedure). Neurological manifestations in Sjögren's syndrome are unusual, but inflammation of the spinal cord may occur.
• Sarcoidosis is a multisystem inflammatory disease of unknown cause, manifested by enlarged lymph nodes, pneumonia, various skin lesions, damage to the liver and other organs. In the nervous system, various nerves can be affected, as well as the spinal cord. The diagnosis is usually confirmed by a biopsy, confirming signs of inflammation typical of sarcoidosis.

Spinal arachnoiditis

Spinal arachnoiditis is an inflammation accompanied by scarring and fibrous thickening of the arachnoid membrane of the spinal cord. Spinal arachnoiditis can lead to compression of the nerve roots and sometimes the spinal cord. Spinal arachnoiditis can also be a postoperative complication or aftereffect from the introduction of radiocontrast agents (for myelography), antibiotics and other chemicals into the subarachnoid space.

Anatomy of the membranes of the spinal cord and surrounding structures of the spinal canal.

Soon after an adverse effect, a large number of cells and a high concentration of protein can be detected in the cerebrospinal fluid (CSF, cerebrospinal fluid), but then the inflammatory process subsides. In the acute period of spinal arachnoiditis, the patient may have a slight increase in temperature. Bilateral asymmetrical radicular pain in the extremities may also be expressed. With spinal arachnoiditis, signs of compression of the roots are determined in the form of loss of tendon reflexes. Back pain and symptoms of root irritation are associated with lumbar arachnoiditis more often than should be the case. In addition, spinal arachnoiditis is not a common cause of spinal cord compression.

Approaches to the treatment of spinal arachnoiditis among neurologists and neurosurgeons are controversial. In some patients, improvement occurs after laminectomy (removal of part of the vertebral arch). Multiple meningeal arachnoid cysts located along the nerve roots may be a congenital anomaly. Increasing in volume, these arachnoid cysts cause deformation or stretching of the spinal nerve roots and ganglia, causing severe radicular pain in adult patients.

2.Symptoms and diagnosis of myelitis

Acute and subacute course of myelitis is characterized by general infectious symptoms:

• high temperature (38-39°C);
• weakness, increased sweating;
• chills;
• loss of strength, apathy.

Neurological manifestations begin with mild back pain and progress to motor, sensory and pelvic disorders. A characteristic sign of myelitis is the irradiation of pain to areas of the body adjacent to the spine. The development of symptoms often occurs rapidly within 1-3 days. The nature and intensity of the disorders depend on the location of the source of inflammation in the spine (thoracic, upper cervical, lumbar, and sacral myelitis are distinguished). Damage to the upper parts of the spine is especially dangerous, as it threatens to stop breathing. The following clinical picture is possible:

• peripheral paraparesis or paraplegia of the lower extremities;
• lack of deep reflexes;
• convulsions;
• retention or incontinence of urine and feces;
• spastic paralysis of the legs;
• bulbar and respiratory disorders;
• hypoesthesia and anesthesia.

With the development of acute transverse myelitis, regardless of the location of the source of inflammation, the phenomena of diaschisis with a general decrease in muscle tone are observed.

Diagnosis of myelitis is mostly traumatic, since the clearest picture is given by lumbar puncture. Additional diagnostic techniques include MRI, CT of the spine and myelography. Often, a visible symptom complex allows a preliminary diagnosis to be made. Additional studies only confirm it, allowing it to be differentiated from epiduritis, acute Guillain-Barré polyradiculoneuritis, tumor diseases, and acute cerebrospinal circulatory disorders.

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Course of the disease

Researchers talk about three options for the development of the disease. In acute transverse myelitis, neurological symptoms are observed within two weeks. After this comes the recovery stage. Later, for an indefinite period, residual effects persist or gradually disappear.

In the second option, the main symptoms remain for life.

The third type, like many other neuromuscular pathologies, is characterized by the gradual development and ascending spread of the inflammatory process with subsequent damage to the trunk. Demyelinating lesions appear in the brain.

Myelitis of the spinal cord

Myelitis is a neurological disease in which several types and types of disease are distinguished. Each type of spinal cord myelopathy has its own characteristics of the course of the disease, symptoms and severity of their manifestation, as well as methods of treatment and further prognosis. The disease may appear after the virus and its toxic substances have penetrated the spinal cord. Inflammation can affect the body of the spinal cord, its processes, nerve endings and roots, as well as various membranes.

Recovery prognosis

According to clinical practice, the prognosis for spinal cord myelitis largely depends on the cause and severity of the disease. In the vast majority of cases, purulent myelitis has an unfavorable outcome. An extremely negative prognosis is observed in ascending forms of the disease, when the inflammatory process spreads to the brain stem. Mechanical ventilators offer the opportunity to save some of the patients.

The prognosis is aggravated by the spread of the infectious process to other organs, forming purulent foci (abscesses) in them. In uncomplicated forms of spinal cord myelitis, approximately 30% of patients with a favorable course and adequate treatment can expect a complete recovery. As clinical experience shows, if neurological disorders do not go away for more than 90 days, then the prognosis for complete recovery is quite doubtful.

With timely diagnosis and persistent treatment, improvement in the patient’s condition occurs after 2-3 months, and maximum restoration of the body’s functioning occurs after 1-2 years. With paralysis of both legs, the patient is assigned the first disability group, and with residual paralysis of the legs and weakness of the sphincters - the third disability group. Partial paralysis of the legs and gait disturbance are the reasons for recognition of the second disabled group with a ban on employment.

What it is?

Myelitis refers to all inflammatory processes of the spinal cord affecting the gray and white matter, or any spinal inflammation. They can be primary and secondary; the causes of primary processes, which are viral in nature, largely remain a mystery.

Secondary myelitis can manifest itself as complications of many diseases - measles, scarlet fever, typhoid fever, influenza, HIV infection, tuberculosis, syphilis and others.

The severity of the symptoms of the disease varies and depends on the form and its prevalence, but in any case it is severe, difficult to cure, and is fraught with serious complications. Sources of infection and the poisons (toxins) they release, entering the spinal cord through the lymphatic and circulatory system, lead to inflammatory and dystrophic abnormalities in it. Viral myelitis affects the spinal membranes, roots and nerve endings.

Picture of the course of the disease

Factors causing the disease lead to swelling of the spinal cord. Its beginning is considered to be the moment when the pathological process is launched, the next stage of which is the appearance of blood clots in the vessels due to circulatory disorders. And this leads to worsening swelling, i.e. the neurological process proceeds in an unbreakable circle.

Partial or (in some areas) even complete circulatory disorder provokes maceration (softening) and death (necrosis) of tissues. During the process of rehabilitation after an illness, areas of necrosis grow with connective tissue, i.e. transform into scars.

Scar tissue is unable to function, which causes pathological abnormalities (some or many) to become permanent. The spinal substance remains swollen, replete with infiltrates and hemorrhages, loses elasticity, and the “butterfly” retains its vague outline.

Classification

In most cases, the exact cause of myelitis is not known, but the factors that provoke it have been identified.

Diseases are classified according to etiology or cause of occurrence into four types:

1. Infectious. This is the most common form, because observed in almost half of patients. It is divided into primary, when the infection initially entered the spinal cord, and secondary. In this case, inflammation of the spinal cord is a complication of another disease. Infectious myelitis is most often of a viral nature, sometimes it is provoked by a meningococcal infection. Secondary infection is often observed with osteomyelitis of the spine or due to infection through the blood when the whole body is affected. In addition to general intoxication, in these cases symptoms of a specific viral or bacterial disease also appear. For example, with measles it is a cough and a characteristic rash.
2. Intoxication myelitis in many cases is a consequence of acute or chronic poisoning (harmful production) with salts of heavy metals, solvents, and alcohols.
3. Traumatic – due to spinal injury. This includes mechanical damage or compression of the spinal cord with disruption of its functions, and possible penetration of infection into the spinal canal through an open wound.
4. Neuroallergic (autonomic). It is caused by systemic diseases, for example, in multiple sclerosis, myelitis is one of the signs of the disease. It also manifests itself in the early stages of the appearance of cancerous tumors.

Diagnostics

To confirm concerns about the development of myelopathy in one or another part of the spine, the neurosurgeon first conducts a physical examination with palpation of the places where pain and discomfort is felt. This is followed by a thorough history taking to determine the reasons why the pathology may have developed.

Only on the basis of the data obtained does the doctor make a decision to conduct further diagnostics using instrumental research methods:

• radiography;
• densitometry - a procedure during which the density of bone tissue is assessed;
• CT;
• MRI.

Along with instrumental studies, laboratory studies are also carried out:

• general and detailed blood test;
• analysis for protein and immunoglobulins;
• spinal fluid puncture;
• biopsy of soft and bone tissues.

Thanks to a comprehensive examination, it is possible to make an accurate diagnosis, on the basis of which the doctor will make a decision on the use of the most effective methods of treating myelopathy.

Treatment

If signs of myelitis are detected, treatment is carried out in the hospital. There, proper treatment and care will be provided under the supervision of medical personnel. When the ability to move deteriorates and sensitivity decreases, it is important to prevent bedsores and maintain healthy skin.

Drug therapy

Inflammation is controlled with glucocorticosteroids. The treatment method is selected by the doctor based on the cause of the disease. If the infection is infectious, the use of antiviral and bacterial agents is indicated. Intoxication is an indication for rinsing. For signs of sclerosis, immunosuppressants and interferons are prescribed.

Treatment for urinary problems involves inserting a catheter. To prevent infection of the genitourinary system, rinsing is carried out.

Relieve muscle stiffness and spasms with the help of muscle relaxants. Anticholinesterases help restore the conduction of nerve impulses.

To prevent the appearance of bedsores, potassium permanganate is used to wash the skin and medicinal ointments. The development of gangrene is an indication for surgical intervention.

Physiotherapy

Patients with myelitis receive massage and electrical stimulation. During the recovery period, it is recommended to do light exercises, if possible, and visit sanatoriums where there is mud therapy.