ENTsEFALOMIELYT (encephalomyelitis; Greek enkephalos a brain + a myelitis) — group of the acute infectious diseases which are characterized by multifocal defeat of preferential white matter of a head and spinal cord, sometimes with involvement in process of peripheral nerves.
Encephalomyelitis can be primary and secondary. Acute primary E. are independent diseases. Secondary E. arise as a complication of the general inf. diseases or vaccination.
For the first time the acute scattered myelitis is described in 1874 by K. Vestfal. Kyussner (V. of Kussner) and F. Brosin in 1886 allocated a myelitis with preferential defeat of white matter and existence of secondary degenerative changes. A concept about E. as independent disease Finbelnburga (Finbelnburg, 1901) and Müller was approved after publication of works of Kramer (Cramer, 1888) (Miiller, 1904). In a crust, time acute primary infectious E. consider as independent a wedge, the form entering into group of demyelinating diseases (see). Among the diseased persons of young age prevail. The disease is registered all the year round, however flashes it are noted more often in the spring and in the fall. In relation to other neuroinfections which are found at children and adults, AA. makes 3,7%.
Etiology acute primary infectious E. to a crust, time is not determined. Its virus nature is allowed, however the activator is still not identified. Etiology secondary E. is defined by a basic disease. The most wide recognition was gained by the autoimmune theory of a pathogeny primary and secondary E. As a starting factor serve, apparently, various activators of the virus nature, to-rye are the reason of formation in a nervous system of autoantigenny substances and autoantibodies to substance of a brain (see Autoallergichesky diseases). The caption of autoantibodies depends on depth patol. process and it' an outcome, napr, at heavy disease the caption increases.
Along with changes of humoral immunity at E. also cellular reactivity changes. It is established that in an acute stage of a disease the expressed proliferative reaction of lymphocytes is observed, edges at the recovered persons and at patients with the residual phenomena disappears. As one of mechanisms of development E. also vascular disorders are considered, to-rye are registered at most of patients.
Main component patomor-foul. pictures acute primary infectious E. disintegration of a myelin and death of axial cylinders is. Defeat and gray matter of a head and spinal cord, and also a complex of infiltrative and proliferative changes of a mesenchymatous system and a number of rough secondary changes in nervous tissue in the form of mezoglialno-gis-thiocytic small knots and proliferation of a mesoglia in white matter of a brain is noted. Besides, inflammatory process takes roots of a spinal cord and a cover of a head and spinal cord.
Patomorfologiya secondary E., as postinfectious, and the post-vaccine of lny, is characterized by perivenous inflammatory process with existence of the okolososudisty centers of demyelination. Process can extend to axial cylinders and gray matter. In the outcome of a disease, as well as at primary E., formation of a glial hem usually is not observed.
Wedge, manifestations E. are diverse. At most of patients they develop sharply, usually after various provocative factors (flu, quinsy, overcooling, etc.). Sometimes in an onset of the illness fervescence, a headache, vomiting, paresthesias in different parts of a body, an oglushennost is noted.
Nevrol. the symptomatology develops quickly (within 3 — 10 days) and in connection with prevalence of process extremely of a polimorfn. At E. all departments
of the central and peripheral nervous system can be surprised, however in one cases prevail polusharny, and in others — trunk or spinal symptoms. Spinal defeats quite often proceed at the phenomena of a cross myelitis (see) or Broun-Sekar's syndrome (see Broun-Seka-ra a syndrome), in some cases they have widespread character. A hemiplegia and a paraplegia more often happen spastic. In an onset of the illness can be observed sluggish a paraplegia. Nek-ry patients have an essential place in a wedge, to a picture occupy symptoms of defeat of spinal roots and peripheral nerves (see Neuritis, Radiculitis): pains, paresis and
disorders of sensitivity on feet and brushes, amyotrophy, decrease in tendon and periosteal jerks.
A paraplegia are often combined with conduction and segmented disturbances of sensitivity, disorders of function of pelvic bodies, trophic disturbances up to development of decubituses. Along with spinal symptoms at E. usually there are signs of damage of a brain: nis
tagm, oculomotor frustration. Damage of an optic nerve can be observed (see), a cut has character of retrobulbar neuritis, congestive optic papillas sometimes come to light, the amaurosis quickly develops. In some cases disturbances of swallowing, a dysarthtia, paresis of language, disorder of breath are registered. At bulbar defeats the disease usually proceeds hard and often comes to an end letalno. Cerebellar symptomatology and signs of defeat of subcrustal educations at E. are noted seldom.
Changes of cerebrospinal liquid (see) in an acute stage of a disease are changeable: in one cases proteinaceous and cellular dissociation, in others — a moderate pleocytosis is found. In blood at nek-ry patients the moderate leukocytosis and a little accelerated ROE comes to light.
Disease is characterized by a short phase of increase of symptoms and the subsequent long recovery of the broken functions. At the same time the quicker process develops, rather there occurs recovery of motive functions. Body temperature is usually normalized in 5 — 7 days.
In the residual period most often there are not rough symptomatology of multiple defeat of a nervous system, preferential pyramidal, and disturbances of sensitivity. Quite often lost functions are recovered slowly, the resistant residual phenomena remain. At neuritis of optic nerves sight often remains broken. Symptoms of a radiculoneuritis, as a rule, disappear.
Proceeding from preferential localization patol. process, allocate an encephalomyeloradiculitis, a polioencephalomyelitis, optiko-encephalomyelitis, an opticomyelitis (Devik's disease), the disseminated myelitis, Redlikh's disease — Fla-tau. An encephalomyeloradiculitis — the most common form E., characterized by damage of all parts of the nervous system. A polioencephalomyelitis — version E. with preferential defeat of kernels of cranial nerves, a brain trunk and gray matter of a spinal cord. Optiko-entsefalomiyelit and an opticomyelitis — similar diseases, to-rye are characterized by a combination of neuritis of optic nerves to symptoms of damage of a head and spinal cord. The disseminated myelitis (see the Myelitis) differs in damage of a spinal cord at its different levels. Sometimes allocate also acute demyelinating E., however, according to a number of researchers, this form most likely is the beginning of multiple sclerosis. Redlikh's disease — Flatau, for the first time described by Redlikh (E. Redlich, 1927) and Flatau (E. Flatau, 1929), is one of forms E., in a wedge, a picture to-rogo along with sensory-motor disturbances neurovegetative symptoms are noted.
The Vilyuysk encephalomyelitis is studied by A. N. Shapoval (1955) and Item A. Petrov (1958). Treats slow viral infections. The disease meets in Yakut the ASSR, is preferential in the valley of the Vilyuy River. For a wedge, pictures of a disease are characteristic extrapyramidal rigidity, the lower spastic paraparesis, vegetative disturbances, decrease in intelligence, conduction and segmented disturbances of sensitivity. In detail — see Encephalitis.
It is described progressing E., at Krom the main a wedge, symptoms are the muscle tension and cricks of muscles arising at various external irritations. Allocate also so-called mialgicheskiya E., for to-rogo along with all-brain and focal symptoms the expressed muscular pain syndrome is characteristic.
Among complications E. are most often observed pneumonia (see), cystitis (see), pyelonephritis (see).
Duration of a current E. fluctuates over a wide range. At an acute onset of the illness nevrol. the symptomatology is shown on 2 — the 3rd week, in cases of the subacute beginning E. — within 2 — 3 months. The recovery period on average fluctuates from 6 months to 3 years. At a part of patients symptoms of defeat of a nervous system disappear completely, at others the residual phenomena of different degree of manifestation remain.
The diagnosis is based on data a wedge, pictures and features of disease. Laboratory methods of a research of great value in diagnosis E. have no.
Differential diagnosis primary infectious E. carry out with multiple sclerosis (see) that quite often presents great difficulties and often happens possible only at long observation of the patient. Emergence of new symptoms and instability separate of them testify in favor of multiple sclerosis. Acute period E. differs from multiple sclerosis in more rapid current and bigger expressiveness patol. process. The polioencephalomyelitis often should be differentiated with a tick-borne encephalitis (see a tick-borne Encephalitis) and poliomyelitis (see). In this case it is necessary to be guided on epidemiol. data, wedge, manifestations and results of laboratory diagnosis. In case of need apply X-ray contrast and tracer techniques of a research.
Main goal of treatment E. consists in bystry stopping patol. process in an acute stage of a disease. For this purpose use corticosteroids (Prednisolonum, dexamethasone). Prednisolonum is appointed inside to 50 — 60 mg a day during 2 — 3 weeks, then the amount of the accepted drug is gradually reduced during 1g/2 — 2 months. At the same time appoint anabolic steroids (Nerobolum, retabolil), drugs of potassium and calcium, ascorbic to - that, veroshpiron. Among symptomatic means the important place is taken by spasmolysants: Mellictinum, skuta-
mil-Ts, Baclofenum, etc.
In the recovery and residual periods E. widely apply physical therapy — massage, to lay down. gymnastics, ozoceritotherapy or paraffin therapy, electrophoresis. At an incontience of urine use electrostimulation of a bladder, the ascending perineal shower; in the absence of effect of conservative therapy an operative measure — reinnervation of a bladder is recommended. For the purpose of fight against spasticity appoint electrostimulation of peripheral nerves and vibrostimulation of muscles and sinews. At moderately expressed motive disturbances it is shown a dignity. - hens. treatment: bathtubs (radonic, brine, sea, hydrosulphuric) and mud cure. In all stages of a disease widely use vitamins of group B and biostimulators.
The forecast for life favorable, except for forms E., to-rye are followed by acute bulbar disorders and defeat of kernels of the phrenic nerves leading sometimes to a lethal outcome. In some cases perhaps complete recovery of working capacity.
Prevention E. it is not developed. Bibliography: Demyelinating diseases of a nervous system in clinic and an experiment, under the editorship of D. A. Markov, page 7, Minsk, 1970; Zinchenko A. P. Multiple sclerosis and encephalomyelitis, L., 1973; Leonovich A. L. Infektsi-onno-allergicheskiye encephalomyelitis and polyradiculoneurites, Minsk, 1973; The multivolume guide to neurology, under the editorship of S. N. Davidenkov, t. 3, book 1, page 429, M., 1962; Behan P. O. Postinfections encephalomyelitis, some aetio-logical mechanisms, Postgrad, med. J., v. 54, p. 755, 1978; Frank G. Progre-dient-perniziose Verlaufe bei chronischer Encephalomyelitis disseminata (MS) mit totaler diffuser optico-spinaler Sklerose, J. Neurol. (Berl.), Bd 212, S. 23, 1976; Kiissner B. Brosin F. Myelitis acuta disseminata, Arch. Psychiat., v. 17, p. 239, 1886; T o r v i with A. a. Slettebo M. Encephalomyelitis with polyneuropathy, Acta neurol. scand., v, 61, p. 287, 1980.
O. A. Hondkarian, I. A. Zavalishin.