Acute disseminated encephalomyelitis

The use of new diagnostic capabilities in medicine has influenced the identification of immediate causes of the series diseases, and, accordingly, the treatment tactics and the natural outcome and consequences on the background of the ongoing activities. So it was revealed that in the development of some demyelinating diseases of the nervous system play the role of infection (viruses, bacteria) and vaccines. Demyelination is the destruction of the myelin sheath of the nerve. The most common of demyelinating diseases are multiple sclerosis and acute disseminated encephalomyelitis (OREM). If in the first case the etiologic factor has not been fully studied, the causes of encephalomyelitis have been elucidated and repeatedly confirmed by numerous studies.

Acute disseminated encephalomyelitis is a demyelinating CNS disease that occurs after a infection or vaccination, characterized by the development of cerebral and focal symptoms and often single-phase flow.

Causes

One of the factors that provoke the development of acute disseminated encephalomyelitis is vaccination

In most clinical cases, the relationship between the development of OREM and previous viral infection or vaccination was described. It is established that in the formation of an immune response against viruses, antibodies are synthesized in the body that begin to attack the myelin sheath of the nerve. Directly the viruses themselves do not cause disseminated encephalomyelitis, but are triggering factors in the development of an autoimmune reaction.

The provoking factors include:

• Viral infections (measles, rubella, chicken pox, tick-borne encephalitis, influenza, etc.).
• Immunization (vaccines against hepatitis B, measles, rubella, poliomyelitis, varicella, pertussis, diphtheria, tetanus, etc.).
• Bacterial infections (borrelia, b-hemolytic streptococcus group A, legionella). Recently, several authors have argued that bacteria can also act as a provoking factor.

In children, most often, encephalomyelitis develops after suffering measles, rubella, chicken pox. In some cases, it is not possible to detect a previous infection.

There are 3 variants of the course of this disease:

1. Acute, monophasic (single-phase).
2. Lightning course, ending with a lethal outcome.
3. Progressing current.

Symptoms

The disease begins with a prodromal period, which occurs on the 4-21 days after the infection or vaccination. The person is reduced in working capacity, there is weakness, malaise. There are rising body temperature, which the patient can not connect with objective causes. The period lasts several weeks, then it gives way to a period of neurological symptoms.

The clinical picture of acute disseminated encephalomyelitis is polymorphic. The clinic distinguishes three main syndromes: intoxication, cerebral symptoms and focal symptoms.

1. Intoxication syndrome.

Patients are disturbed by general weakness, decreased appetite until it is completely absent, body temperature rise to febrile figures (390С- 400С), muscle pain (myalgia). Fever in duration, as a rule, does not exceed 1-2 weeks. Common infectious symptoms may be mild or absent.

1. General cerebral symptoms.

There is drowsiness, headache, vomiting, dizziness, nausea. Some patients experience psychomotor agitation (they say a lot, they laugh, they have an increased motor activity) or vice versa stunning (inhibition in behavior, they say reluctantly, little, long answer to questions). There are generalized convulsive attacks: the patient loses consciousness, falls, there are convulsions in the limbs and trunk, involuntary urination.

1. Focal symptomatology.

On examination, it is revealed 2-3 days after the onset of the disease. The clinical picture depends on which CNS structures are damaged by autoantibodies.

The following variants of OREM are selected, depending on the prevailing focus of damage.

• Disseminated encephalomyelitis.

Gray and white matter of the brain is damaged. There is a feeling of "creeping crawl" along the body, a feeling of tingling, numbness in the hands and feet. Weakness in the hands and feet (parezy). Pain in the extremities. Symptoms can manifest on opposite parts of the body (left arm and right leg, for example).

• Optimichelite.

First of all, damage to the optic nerves, spinal cord, less often the brain. A person is worried about reduced visual acuity right up to blindness, double vision (diplopia), loss of visual fields (scotoma). Visual impairment is combined with paresis (weakness) in the hands and feet, sensitive disorders (numbness, "crawling crawling, pain, etc.), a disorder of the pelvic organs (urinary incontinence, stool retention).

• Polyencephalomyelitis.

The damage to the medulla oblongata of the anterior horns of the spinal cord appears to the fore. Patients complain of a violation of swallowing (dysphagia), a speech disorder (dysarthria), a violation of the shade of the voice (dysphonia), which combines into a bulbar syndrome. Muscles in the body atrophy, there is weakness in the hands and / or feet.

• Meningoencephalomyelomyopolyradiculoneuritis.

It occurs very rarely (more often in cases after vaccination against rabies or transferred measles). Disseminated the entire nervous system (brain, spinal cord, peripheral nerves and rootlets) is damaged. A person complains of severe pain in the body, sensitive disorders, weakness in the muscles.

• Bickerstaff's trichological encephalitis.

Diagnosed in adolescence, often has a subacute current. Young people complain of a gait violation (shaky gait), weakness of facial muscles, speech disorders ("porridge in the mouth"), hearing loss and difficulty in the movement of eyeballs. With this variant of the disease, these symptoms are associated with damage to the brainstem.

• Acute cerebellar ataxia of Westphalia-Leiden.

Children are ill for 2-5 years. Occurs more often after a transferred chicken pox. The cerebellum is affected. In children, there is a gait disorder (cerebellar ataxia), chaotic movements in the arms and legs, accompanied by jitters and misses with purposeful actions (spooning to the mouth, spelling letters, etc.). This option is benign with the full recovery of most children within a few weeks.

Diagnostics

In the cerebrospinal fluid of persons suffering from this pathology, an increased content of leukocytes and protein

1. Clinical examination by a neurologist, infectious disease specialist.
2. Complete blood count (increase in leukocytes, increase in ESR).
3. Investigation of cerebrospinal fluid (the appearance of a large number of leukocytes in the cerebrospinal fluid, an increase in protein).
4. CKT or MRI of the brain and spinal cord.

Treatment

1. Corticosteroids are the drugs of choice in the treatment of disseminated encephalomyelitis (prednisolone, dexamethasone, methylprednisolone).
2. Plasmapheresis is used in severe cases.
3. Antiviral and antibacterial therapy is prescribed when an agent of a previous infection is identified.
4. Symptomatic therapy (maintenance of water-salt balance, relief of epileptic seizures, etc.).

Effects

The recovery period, as a rule, begins in a few days and can last from several months to several years (up to 2-3 years). Complete recovery is found in half of the patients who underwent encephalomyelitis. In some cases, the disease ends in a lethal outcome (10%). In 40% of people a residual period or a period of residual persistent phenomena is formed, which manifests itself as cognitive disorders (decreased memory, attention, absent-mindedness) and / or motor impairment (pareses of varying degrees expression).