Myelitis

　　According to traditional Chinese medicine, myelitis is caused by external pathogenic factors, especially by warm and hot toxic factors. In Western medicine, the exact cause of myelitis has not yet been determined. Myelitis is mostly an autoimmune reaction caused by viral infection, or spinal inflammation caused by reasons such as poisoning or allergy.

　　The pathogens mainly include influenza virus, herpes zoster virus, rabies virus, poliomyelitis virus, and so on. In recent years, there have been reports of myelitis caused by hepatitis virus. A portion of the patients have an unknown cause, but they often have symptoms of upper respiratory tract infection before the disease. Clinically, transverse myelitis is the most common, with the lesion mainly located in the thoracic segment, followed by the cervical segment, and the lumbar and sacral segments are less commonly affected. It is characterized by paralysis, sensory loss, and bladder and rectal dysfunction below the level of the spinal cord lesion.

　　Common complications of myelitis include:

　　(1) Bedsores, acute myelitis is prone to complications of bedsores.

　　(2) Decubitus pneumonia.

　　(3) Abnormal defecation function: constipation

　　(4) Urinary tract infection and urinary retention.

　　The symptoms of myelitis include:

　　A history of upper respiratory or intestinal infection, vaccination history, or triggers such as catching a cold, overexertion, carrying heavy loads, sprains, etc., may occur several days or 1-2 weeks before the onset of myelitis. Myelitis has an acute onset and can lead to complete paralysis within a few hours to 1-2 days. Some patients may have prodromal symptoms such as back pain, a band-like sensation, limb numbness, and weakness before the onset, which gradually develop into complete paralysis within several days to ten days.

　　The clinical symptoms of myelitis can vary depending on the location and extent of the lesion. Due to the longer segment length of the thoracic spinal cord and poor blood supply to some segments, the lesion often involves the thoracic spinal cord. The initial symptom is often numbness and weakness in the lower limbs, corresponding back pain, a band-like sensation, or difficulty in urination. After 2-3 days, the condition reaches its peak, with complete paralysis below the level of the lesion, loss of sensation, hypohidrosis or anhidrosis, and retention of urine.

　　In the early stage of the disease, the patient is in the stage of spinal shock, with flaccid paralysis of the limbs, also known as soft paralysis. After 2-4 weeks, the limbs gradually become spastic paralysis, also known as rigid paralysis, and urinary problems change from urinary retention to incontinence. When the lesion involves the cervical spinal cord, quadriplegia may occur. If it affects the upper cervical segment (C4 and above), respiratory difficulty may also occur. Myelitis can present with soft paralysis of the upper limbs and rigid paralysis of the lower limbs. When the lesion is located in the lumbar spinal cord, the lower limbs present with flaccid paralysis, and muscle atrophy can be seen early. When the lesion is in the sacral spinal cord, there is significant sphincter dysfunction without obvious paralysis.

　　In addition, there is also an ascending myelitis, which has an acute onset and the lesion can develop rapidly from below to above. Often within 1-2 days, even within a few hours, the condition reaches its peak. Symptoms may include paralysis of the limbs, difficulty in swallowing, unclear speech, difficulty in breathing, and even paralysis of the respiratory muscles leading to death.

　　During the period of cold and fever, the body temperature should not exceed 38.5 degrees. At this time, it is necessary to use antibacterial, anti-inflammatory, and antipyretic injections for intravenous infusion or intramuscular injection as soon as possible to kill the bacteria that may cause myelitis in the incipient stage.

　　In cases of external trauma fractures, or contusions, or postoperative infections, when diseases such as bedsores and boils occur, it is necessary to treat the symptoms promptly and accurately, control the further invasion of bacteria, and at this time, large doses of anti-infection, antiviral, and anti-inflammatory drugs can be administered intravenously (or large doses of清热解毒, 凉血活血, 排毒拔毒 Chinese herbal medicine can be taken internally and externally) to expel the infected viruses from the patient's body as early as possible or to dissipate them.

　　Three, in daily life, it is also not allowed to overwork. Overwork can cause the body's resistance to decrease, immune function to be low, and bacteria can take advantage of this to cause osteomyelitis and other diseases.

　　Four, in daily life, if other diseases occur, it is forbidden to abuse or use hormone-containing chemical drugs for a long time during the treatment period. Improper use of these drugs can easily accelerate the hardening of bone tissue, the hardening and obstruction of the bone marrow cavity, cause normal metabolic dysfunction of bone cells, and even lead to bone necrosis.

　　The examination of myelitis is done through the following aspects

　　There are many clinical symptoms of myelitis, mainly manifested as sensory loss, dysfunction of rectal function, and limb paralysis. At this time, timely treatment is needed. When diagnosing myelitis, what examination methods can be used?

　　⒈ Lumbar puncture: Cervical compression test is unobstructed, and in a few cases, severe spinal cord edema can lead to incomplete obstruction. CSF pressure is normal, appearance is colorless and transparent, cell count and protein content are normal or slightly increased, mainly lymphocytes, and sugar and chloride are normal.

　　⒉ Imaging examination: X-ray of the spine is normal. MRI typically shows thickening of the spinal cord at the lesion site, multiple patchy or dot-like lesions in the spinal cord segments, showing T1 low signal, T2 high signal, uneven intensity, and sometimes fusion. Some cases may remain without any abnormalities.

　　①. Spinal cord MRI: It can be seen that the spinal cord is swollen, with uneven long T1 and long T2 signals.

　　②. Spinal cord CT: It is often combined with myelography. It can be seen that the spinal cord is slightly thickened, with uneven density.

　　③. Myelography: How to check myelitis? Commonly seen diffuse swelling of the spinal cord, or it may be normal. It is mainly used for cases with atypical clinical manifestations, and to differentiate from other diseases. Examination during the acute stage can lead to exacerbation of the condition.

　　⒊ Electrophysiological examination:

　　① Visual evoked potential (VEP) is normal, which can be distinguished from optic neuritis and MS.

　　② The amplitude of somatosensory evoked potential (SEP) can significantly decrease; motor evoked potential (MEP) is abnormal, which can be used as an indicator for judging efficacy and prognosis.

　　③ Electromyogram shows denervation changes.

　　4. Blood count:

　　⑴ Blood routine: During acute attacks, the number of white blood cells can increase, mainly polymorphonuclear leukocytes.

　　⑵ Erythrocyte sedimentation rate: It can accelerate during the acute attack period.

　　⑶ Immunological indicators: During acute attacks, the ratio of Th/TS (helper T cells/suppressor T cells) in peripheral blood increases, the level of total complement increases, and the level of immunoglobulins increases. These tend to decrease as the condition improves.

　　Patients with myelitis should eat the following foods

　　Legume foods: Legume foods are rich in protein and trace elements, which promote the metabolism of muscles, bones, joints, and tendons, and help repair damaged tissues. For example: soybeans, black soybeans, and mung beans, etc. They can treat rheumatic bone pain with dampness as the main symptom, and have a good effect on rheumatism with body沉重, joint discomfort, tendons and muscles stiffness or numbness, joint swelling and pain that is heavy and uncomfortable. Black soybeans, also known as Hei Dou and Dong Dou Zi, can also treat rheumatic pain. The experience formula uses black soybeans fried to half-burnt and soaked in yellow wine to treat joint pain effectively.

　　The treatment of myelitis includes

　　One, General Treatment

　　⒈During the acute stage, bed rest should be maintained, and a diet rich in calories and vitamins should be provided. Or drugs such as ATP, coenzyme A, adenosine, and cytidine diphosphocholine can be given to promote the recovery of neural function. The injection of fresh plasma from healthy individuals in small doses and multiple times also helps to improve the patient's immune function and is beneficial to prevent infection and recovery.

　　⒉Frequent turning over, keep the skin clean and dry, pay attention to massaging the compressed areas to prevent bedsores.

　　⒊Severe urinary retention requires catheterization, an aseptic catheter can be left in place, and urine is voided once every 3-4 hours to prevent bladder contracture. During the period of indwelling catheterization, attention should be paid to prevent urinary tract infections. For those with difficulty defecating, timely enema or the use of laxatives should be considered.

　　Two, Adrenal Cortex Hormones

　　It is currently believed that myelitis is related to autoimmune diseases, and corticosteroids can be tried. Hydrocortisone 5-10mg/kg per day is added to 5-10% glucose solution for intravenous infusion, once a day. After 1-2 weeks, the dose can be adjusted according to the situation, or prednisone can be taken orally and gradually reduced and stopped.

　　Three, Other Therapies

　　⒈Plasma Exchange: It can remove harmful substances such as autoantibodies and immune complexes from the patient's plasma, which can alleviate symptoms in critically ill patients, and may also be effective for patients who do not respond to hormone treatment. Generally, once a day, a course of 7 days.

　　⒉Oxygenated Autologous Blood Irradiation: 150-200ml of the patient's own whole blood is taken, oxygenated and irradiated with ultraviolet light, and then returned. Once or twice a week, for 3-5 weeks. It can promote the recovery of spinal cord function.

　　Four, Recovery Period Treatment

　　⒈Early onset of functional exercise should be encouraged, attention should be paid to maintain the limbs in functional positions to prevent the limbs from becoming contracted or deformed.

　　⒉Patients who have already developed contractures or deformities should receive physical therapy, physical therapy, and other treatments to further strengthen training, or small doses of tranquilizers or antiparkinsonian drugs may be taken orally to relieve muscle tension.