Infectious myelopathy is a neurological disease that is expressed by disorders of a motor, conductive or sensitive nature. The clinical picture of this pathology depends on the level of spinal cord injury. In this regard, loss of sensitivity (pain, tactile), paralysis, certain disorders of the musculoskeletal system, pathological processes of the pelvic organs (violation of urination, etc.) may appear. The diagnosis is established on the basis of data from a clinical blood test, culture of the latter and cerebrospinal fluid for sterility, X-ray and electromyography, CT and MRI of the spine, angiographic examination. Treatment includes antibiotic or antiviral therapy, painkillers and antipyretic drugs. Physiotherapy is also used. Surgical treatment is indicated for compression of the spinal cord.
G04 Encephalitis, myelitis and encephalomyelitis
Infectious myelopathy (infectious myelitis) is an inflammation of the spinal cord of infectious etiology. Depending on the infectious disease that caused the development of myelopathy, it gets an appropriate name: for example, herpetic or syphilitic myelopathy. Since the term includes a group of diseases that differ in etiology, there is no exact data on the prevalence of the disease in neurology. The pathological process has no age preferences, for women and men the risk of developing the disease is the same. The disease has a high social and medical significance, due to the possible risks of life-threatening complications and often resulting in disability of the patient.
The cause of this group of myelopathies are certain infectious diseases: epidural abscess (as a consequence of osteomyelitis of the spine, skin infection (pyoderma), septicemia, intravenous administration of narcotic drugs, head trauma, spinal surgery or spinal puncture); AIDS; syphilis; herpes zoster; rheumatoid arthritis; Lyme disease (borreliosis); multiple sclerosis.
For infectious myelopathy, regardless of the cause of its occurrence, common symptoms are characteristic: chills, general weakness, an increase in body temperature to 39 ° C, redness, swelling and soreness of the site of inflammation. Neurological symptoms develop gradually and depend on the level of the spinal cord at which the focus of inflammation is located. There are sensitive disorders, dysfunction of the pelvic organs, disorders in the musculoskeletal system.
So, if pathological changes occur in the upper cervical region (C1-C4) of the spinal cord, there is spastic paralysis of the limbs, violation of pain sensitivity downwards, shortness of breath and hiccups due to irritation of the diaphragm, violation of urination. Often there are pains in the neck and back of the head. The lesion of the lumbar thickening (L1-S2) is characterized by sluggish paralysis in the legs, lack of pain sensitivity in the lower extremities and in the perineum, violation of urination. Movement and strength in the hands are preserved.
Brown-Secar paralysis, which occurs with a half-lesion of the spinal cord diameter, is characteristic of progressive myelopathy. On the side of the lesion there is spastic paralysis of the limbs, on the opposite side there is a feeling of heat, lack of pain and temperature sensitivity.
The syndrome of complete transverse spinal cord injury often has a viral origin. The patient has lower paraplegia or lack of movement in both arms and legs, loss of all types of sensitivity downwards from the level of the lesion, violations of acts of defecation and urination. Often, transverse myelitis has to be differentiated from Guillain-Barre syndrome.
Complications of the disease can be bedsores, urinary tract infections, damage to the genitourinary system due to the constant retention of urine in a stretched bladder, as well as mechanical respiratory failure in spinal cord pathology at the neck level; PE.
Symptoms of the most common types of infectious myelopathy
Acute enterovirus transient myelopathy is characteristic of childhood. Starting with a banal cold, it is often viewed by pediatricians. The child develops lameness, increasing weakness in the muscles. The prognosis is favorable with a complete regression of symptoms by the 60th day of the disease.
AIDS. The human immunodeficiency virus (HIV) directly affects the spinal cord. Vacuolization of the white matter of the spinal cord occurs, especially pronounced in the thoracic region. Sensitivity changes in this type of myelopathy are not very pronounced, and urinary incontinence occurs very early. HIV encephalopathy is progressing in parallel. The disease has a slowly progressive character and lasts from several weeks to months.
Syphilitic myelopathy is expressed in meningovasculitis of the spinal cord, which often causes the development of a spinal cord infarction – an acute violation of spinal circulation.
Spinal epidural abscess. Most often, the causative agents of this disease are staphylococci, streptococci, gram-negative rods, fungi and anaerobes. A triad of signs characterizes this pathology: an increase in body temperature, rapidly increasing paresis and sharp back pain. The pathological process can be localized at all levels of the spinal cord.
To make a diagnosis, a neurologist prescribes laboratory research methods: a detailed clinical blood test (an increase in ESR, leukocytes indicates the inflammatory nature of the pathology); sowing of blood and cerebrospinal fluid for sterility.
Among the instrumental methods used: radiography of the spine to assess the condition of vertebrae and intervertebral discs, electromyography (magnetic stimulation, EMG), which assesses the passage of electrical excitation through the spinal cord; lumbar puncture to study spinal fluid; MRI of the spine to visualize the spinal cord; CT spine to visualize the bones of the spine; CT angiography to study the blood vessels of the spinal cord (performed with the introduction of contrast).
Treatment should stop the progression of the disease. It depends on the cause that triggered the infectious myelopathy. Therapy is aimed at combating the causative agent of infection and reducing the area of the focus of inflammation. Pathogenetic treatment includes the appointment of antibacterial or antiviral therapy. Antibiotics are usually administered in large doses intravenously for three to four weeks. They are chosen based on the results of bacteriological blood tests.
Symptomatic treatment includes the appointment of muscle relaxants (tolperizone, baclofen) to eliminate reflex muscle spasm that occurs in response to pain. To alleviate the patient’s condition, painkillers (ketorolac), anticonvulsants (carbamazepine), antipyretic drugs (ibuprofen) are prescribed. Physiotherapy is successfully used: acupuncture, massage, micropolarization of the spinal cord.
The indication for mandatory surgical treatment is compression myelopathy. Rehabilitation of patients with infectious myelopathy is very long and complex, carried out with the participation of a neurologist, a vertebrologist and a chiropractor.
Prognosis and prevention
As soon as the cause of infectious myelopathy can be eliminated, it is possible to judge what results to expect from treatment. It is important to determine how much the disease has damaged the spinal cord tissue, whether its substance has been preserved or died. MRI and electroneurography will help to do this. A complete cure is possible if there was no spinal cord injury. If the disease continues to develop, the focus of infection has not been eliminated, complete disability is possible.
Since infectious myelopathy is a consequence of another pathology, its prevention is closely related to the prevention of infectious morbidity.