Inflammation of the gray matter of the brain. Myelitis. Inflammation of the gray matter of the brain in Latin

Encephalitis or inflammation of the brain is a very dangerous disease, the causes of which are usually infectious, i.e. viruses, protozoa and bacteria. Allergic and toxic factors can aggravate the situation. Depending on the provoking factor, the disease can be very unexpected and occur very rapidly, or it can occur slowly, in a latent form. Often, brain inflammation occurs as an independent disease or develops as a complication of another pathology. As a result, it is usually customary to talk about primary and secondary encephalitis.

The causes of primary inflammation, as a rule, lie in the pathogenic action of viruses, which, due to their simple structure, can easily overcome the blood-brain barrier on their way to the medulla. Some protozoa, bacteria and other microorganisms have the same ability. Inflammation can affect and in this case they speak of polyencephalitis, and such a disease can also affect the white matter, then leukoencephalitis is implied.

As a rule, the disease occurs due to the fault of various microorganisms that enter the brain tissue through the circulatory system. The causative agent of a terrible disease can enter the human body itself through the air, through the digestive system, through contact with sick people, animals, or as a result of an insect bite. The latter option can be observed in the example of tick-borne encephalitis.

There are also other causes of the disease:

• trauma, with concomitant damage to the brain substance;
• herpetic infection affecting nerve ganglia;
• vaccination against rabies and tick-borne encephalitis;
• allergic or autoallergic response;
• cerebral hemorrhages;
• tuberculosis;
• dysentery;
• rubella;
• chickenpox;
• malaria;
• flu.

It should also be noted that brain pathological metamorphoses provoked by the inflammatory process cannot be called specific, since they are often found in other NS ailments. They often manifest themselves as a response of brain tissue to a traumatic object without taking into account its genesis.

The reasons for the diversity of reactions lie in the state of the patient’s immunity, which ensures their variability. Thus, swelling, proliferation of microglia, degeneration of nerve fibers and cells most often appear in the acute phase of the disease. While in the chronic form, mainly changes in tissue of a degenerative nature can be observed, and scars or nodules can also be detected.

Symptoms of encephalitis

Clinical signs that indicate the presence of brain inflammation are varied. Symptoms primarily depend on the cause of encephalitis, the phase of the disease and the location of the source of inflammation. Usually,
determine several stages of the disease, which correspond to certain signs. Primary symptoms are characteristic of any infectious diseases. So, in the period from two hours to several days there is elevated temperature, chills, nausea and other gastrointestinal problems. You can talk about purulent inflammation of the brain.

The next stage demonstrates general cerebral symptoms:

• drowsiness and other symptoms of confusion;
• psychosensory disorders;
• soreness in the forehead area;
• high excitability;
• photophobia;
• apathy.

In addition, a sick person may experience stiff neck muscles, that is, the so-called Brudzinski symptoms. These usually include a cervical symptom, which consists of an involuntary bending of the head towards the chest, as well as zygomatic signs, which appear when pressing on the cheek just below the zygomatic arch. In this case, the patient reflexively bends his elbows and raises his shoulders.

In addition, the pubic symptom is quite indicative. It is so called because pressure is exerted on a person’s pubis, as a result of which, when the brain is inflamed, he cannot help but bend his legs at the knee and hip joints.

Also important are focal symptoms of central nervous system malfunctions, which can be a clue in determining the form and location of inflammation. Such symptoms usually include paresis of the limbs, aphasia or epileptic seizures. However, the usual and characteristic symptoms can be supplemented by others if the disease occurs in an abortive or fulminant form.

They have their own specific symptoms. So, for example, when an abortive form of the disease occurs, there are no neurological symptoms, but it has signs of an acute respiratory or gastrointestinal infection. The fulminant form of the disease is very dangerous, since it often ends in the death of the sick person.

Diagnostics and therapeutic therapy

It should be noted that the diagnosis of “encephalitis”, however, like “meningitis”, can be confirmed only after a sample of the cerebrospinal fluid is carefully examined. To confirm suspicions of brain inflammation, the resulting sample must contain a protein content exceeding the norm and
an overwhelming number of white blood cells. Only after receiving this data do they begin to treat the disease.

It must be emphasized that encephalitis is a very serious disease, so the prognosis cannot be favorable in all cases. It is extremely important that a sick person receives timely and effective medical care. Treatment of the disease is pathogenetic, symptomatic and etiotropic in nature. The treatment also assumes that auxiliary rehabilitation procedures will be carried out.

Pathogenetic treatment includes measures against dehydration and the formation of swelling, and is also aimed at desensitization. In addition, treatment is carried out using hormonal therapy, which has anti-inflammatory and protective properties, is aimed at stabilizing blood circulation in the brain, maintaining water and electrolyte balance and involves the introduction of angioprotectors and antihypoxants. In addition, treatment may include other measures designed to stabilize brain metabolism.

Etiotropic treatment comes down to the use of antiviral drugs, for example, such as nuclease, which blocks the reproduction of the virus or interferon. In circumstances where confusion or convulsions are observed, treatment involves the administration of Mannitol. Transfusion of intravenous immunoglobulins can also be performed during therapy.

Symptomatic treatment is characterized by several directions. Its main task can be called:

• decreased body temperature;
• elimination of epileptic seizures;
• normalization of mental state;
• achieving an ideal regime of activity and rest.

If we talk about restorative procedures, they involve therapy against paresis, parkinsonism, epilepsy and neuroendocrine disorders.

Although inflammatory processes in the brain area are not such a common pathology, nevertheless, it still occurs and, alas, takes human lives. However, death is often observed only when seeking medical help is delayed and in a situation of neglect of one’s own health.

Almost any disease can be treated at the initial stage, but the desire to eliminate its symptoms on your own only complicates the situation. This is why it is so important to seek help on time.

Scientists of antiquity probably encountered such a severe pathology as encephalitis, but since medical knowledge was just in its infancy, there were no accurate diagnostic methods, and there was no understanding of microorganisms at all, inflammatory processes in the brain, often accompanied by an increase in body temperature, were simply classified as fevers, a change consciousnesses in which no one is surprised to this day.

As medical science has developed, sufficient evidence has accumulated that inflammation is possible not only in tissues visible to the eye, but also in internal organs, and the brain is no exception. Neurological symptoms against the background of clear signs of intoxication and fever make it possible to suspect encephalitis already upon examination of the patient, although the exact cause of the disease cannot always be determined.

The causes and forms of brain inflammation are quite diverse, but A special place is occupied by tick-borne encephalitis, which is a dangerous independent disease, often leading to a tragic outcome. We will pay special attention to tick-borne encephalitis a little lower.

Despite the variety of causes and types of encephalitis, its manifestations are quite stereotypical in severe cases of the disease, but if inflammation of the nervous tissue accompanies other ailments, then recognizing encephalitis as such is not so easy. It happens, for example, that changes in consciousness, headache, vomiting and other signs of trouble in the brain are attributed to intoxication, fever, and dehydration. By and large, if encephalitis is secondary in nature to other serious diseases and develops as a complication, then by that time the patient is already receiving a fairly wide range of medications, and the hospital has the opportunity to quickly conduct relevant studies. This cannot be said about a special form of brain damage – tick-borne encephalitis. A tick bite does not make everyone want to examine it for infection, and then the disease can take them by surprise.

Inflammation of brain tissue is a serious process that, at worst, dooms death, and at best, severe changes in the activity of the nervous system and natural disability. A relatively favorable outcome with encephalitis, although it does happen, is quite rare, so any suspicious symptoms regarding brain damage should not go unnoticed by the doctor.

Types and causes of inflammation in the brain

Depending on the reason, there are:

1. Encephalitis of infectious origin (viral, bacterial, fungal).
2. Toxic encephalitis due to poisoning with various poisons.
3. Autoimmune encephalitis.
4. Post-vaccination.

In most cases, encephalitis is caused by viruses or bacteria that enter the brain with blood or lymph flow. Some microorganisms immediately choose nervous tissue as the most favorable habitat for themselves (neurotropic viruses), while others end up there during a severe course of an infectious disease of another localization.

In case of influenza, measles, HIV infection, rubella or chickenpox, brain damage is secondary and characteristic of severe forms of these diseases, while rabies, herpes, and tick-borne encephalitis viruses initially select nervous tissue for their vital activity, without affecting other organs . Most neurotropic viruses tend to cause epidemic outbreaks of disease with clear seasonality and geographic features. In hot countries with an abundance of blood-sucking insects, in the taiga, where tick activity is very high, outbreaks of encephalitis are recorded quite often, therefore, alertness among medical workers in these regions is extremely high during periods of maximum risk of infection, and the population is informed about the possible consequences of the disease and is actively vaccinated.

map of the predominant distribution of viral tick-borne encephalitis

Bacterial encephalitis is somewhat less common and can occur with purulent inflammation and involvement of the pia mater (meningoencephalitis).

The main route of spread of infection to the brain is considered to be hematogenous (through the bloodstream), when after a mosquito or tick bite, viruses enter the bloodstream and are sent to the nervous tissue. Contact and household transmission, airborne droplets (herpes), and nutritional transmission through the gastrointestinal tract (enteroviruses) cannot be excluded.

However, microbes are not always the cause of brain damage. In some cases, encephalitis develops against the background of the toxic effects of various poisons (heavy metals, carbon monoxide), an autoimmune process, and an allergic reaction.

Frequent vaccinations and failure to comply with the dates specified in the vaccination calendar can also cause inflammation of the brain. The most dangerous vaccines in this regard are DTP vaccines, against smallpox and rabies, which can contain live microorganisms and, under certain conditions, cause complications in the form of brain damage.

It is often not possible to establish the exact cause of the disease, so the localization, prevalence and course of encephalitis are also taken into account. If the inflammatory process began initially in the brain, and the changes are limited to the nervous tissue, then encephalitis will be called primary. In this case, most often the culprit will be a neurotropic virus. ABOUT secondary encephalitis they say when there are prerequisites for the subsequent involvement of the brain in the pathological process in other diseases: severe measles or flu, immunity disorders, malignant tumors, autoimmune process, HIV infection, etc. The identification of these forms is reflected in subsequent treatment tactics patient.

The inflammatory process may primarily affect the white matter of the brain ( leukoencephalitis), or gray (bark), then they talk about polioencephalitis. Inflammation of both white and gray matter, together with the nerve pathways, represents the most severe form of brain damage - panencephalitis. In some cases, not only the substance of the brain is involved, but also its membranes, in particular the vascular membrane; this condition is called meningoencephalitis.

What happens with encephalitis?

Changes in nervous tissue during encephalitis are quite stereotypical, and only in some cases can signs of a specific disease be detected (rabies, for example). The significance for the body and the consequences of any inflammatory changes in the brain are always serious, so there is no need to once again remind us of their danger.

Swelling, hemorrhages, accumulations of inflammatory blood cells (leukocytes), destruction of the membranes and processes of neurons themselves lead to irreversible changes, and the low ability of nervous tissue to regenerate does not give patients a chance for a favorable outcome and restoration of lost functions.

The structures of the subcortical nuclei, white matter, medulla oblongata and brainstem are often damaged, therefore, the manifestations are not limited to general cerebral symptoms, and the indispensable companions of such encephalitis will be paralysis, respiratory failure, cardiovascular system function, etc.

In addition to damage to nerve cells, the patient's condition is aggravated by increasing cerebral edema, which certainly accompanies any inflammation, regardless of its nature and location. Enlarged in volume, the edematous brain does not fit well in the skull, increases in size, and the patient’s condition progressively worsens. Along with damage to vital nerve centers, swelling can cause death in encephalitis.

With a bacterial infection, the inflammation often takes on a purulent character, spreading to the pia mater. In such cases, in addition to foci of purulent melting in the brain tissue, a kind of “cap” or, as they are also called, “purulent cap” is formed, enveloping the already suffering brain. This condition is very, very dangerous, and delay in getting medical help can cost your life.

Manifestations of encephalitis

Signs of encephalitis are determined by the cause, the localization of the source of inflammation, the course of the disease, but in most cases, against the background of focal neurological changes, they are expressed and general symptoms of brain damage. These include:

• , often intense, all over the head, without clear localization.
• Nausea and vomiting, which does not bring relief, which makes it possible to exclude pathology of the gastrointestinal tract in favor of the brain.
• Impaired consciousness - from mild drowsiness to coma with loss of response to external stimuli.
• A fever in which the temperature usually exceeds the threshold of 38 degrees and is difficult to reduce because it is associated with damage to the corresponding brain structures.

The focal symptoms of encephalitis are determined by which part of the brain the pathological changes are most pronounced. Thus, patients may lose the ability to coordinate movements when the cerebellum is involved, vision is impaired when the occipital lobe is damaged, pronounced changes in the intellectual sphere and behavioral reactions accompany inflammation in the frontal lobes.

Encephalitis can occur in the so-called abortive form, when the symptoms of brain damage are limited to moderate pain in the head and stiff neck. If such symptoms, fever, or signs of respiratory or gastrointestinal infection are present, it is necessary to examine the cerebrospinal fluid to exclude brain pathology.

Tick-borne encephalitis

Having set out to learn a little more about inflammatory processes in the brain, it is easy to notice that most of the information on this problem is devoted to tick-borne encephalitis. This is not surprising, since tick-borne encephalitis, being an independent disease, affects absolutely healthy people of any age and gender, and the seasonality and mass nature of infection with the infectious agent force not only health workers, but also people at risk to understand the essence of the disease.

The danger of tick-borne encephalitis is that in almost all cases it leaves behind persistent neurological disorders, which not only limit the subsequent life of the person who has been ill, but also capable of chaining him to bed forever. In children, the disease is more severe than in adults, and residual effects and dangerous consequences can radically change the life of a little person, not for the better.

A little history

The first published descriptions of a seasonal disease that occurs with damage to the nervous system appeared at the end of the 19th century. In the first third of the last century, large-scale scientific research was carried out, which bore fruit: the pathogen (virus) was isolated, the carrier (tick) was identified, the clinical picture of the disease was described in detail, treatment approaches were developed and, most importantly, preventive measures.

However, the study of tick-borne encephalitis, like any other infectious disease, did not pass without tragic episodes when the dedicated work of scientists led to their death.

The development of Siberia and the Far East in the 30s of the last century, the development of industry and the strengthening of the border required an influx of qualified personnel into these regions, and along with the construction of numerous correctional institutions led to the resettlement of a huge number of people for whom the climate and natural features of the area were alien. It was then that massive outbreaks of seasonal disease affecting the central nervous system attracted the attention of A.G. Panov. Already in 1937, an expedition was organized under the leadership of Professor L.A. Zilber, whose participants began to closely study the nature of encephalitis.

dog and taiga ticks - both can be carriers of encephalitis

Thanks to the efforts of virologists, infectious disease specialists, with the active help of Khabarovsk neurologists who had first-hand knowledge of the dangerous disease, the causative agent of the infection was identified, which turned out to be a virus, as well as the most likely carrier - the ixodid tick, whose favorite habitat is considered to be taiga regions.

The disease spared no one. Most of those who were bitten by a tick developed encephalitis, and the risk of death remained and remains quite high. Among the victims of the insidious infection are many scientists, employees of virology laboratories, and doctors who conducted research in the field. Thus, one of the discoverers of the viral nature of tick-borne encephalitis, M.P. Chumakov, contracted the infection during an autopsy of a deceased patient. The acute form of the disease gave way to a chronic one and haunted the scientist for the rest of his life. Despite his hearing impairment and movement disorders, Academician Chumakov continued to work actively for many years, and bequeathed his body for the study of the chronic form of encephalitis that had lasted for decades. One of the entomologists, B.I. Pomerantsev, who searched for the carrier of the infection, died after being bitten by a tick from a severe form of encephalitis.

There was also politics. Soon after the start of the expedition, in the midst of research work, its leader, Professor Zilber, and two other employees were arrested, who were suspected of spreading Japanese encephalitis in the region, but the accusation was false, and 1937 was marked by the discovery of the tick-borne encephalitis virus thanks to dedicated Russian scientists.

Where does the infection come from?

As noted above, tick-borne encephalitis is common in the forest and forest-steppe zones of Siberia, the Urals, the Far East, and is found in many countries of the central and western part of the Eurasian continent (France, Germany, Poland, Belarus, the Baltic region). Cases of tick-borne encephalitis have also been recorded in Mongolia and the wooded part of China. Every year in Russia alone, more than half a million people, including children, seek medical help after a tick bite. The infection is especially severe among residents of the Far East, where the incidence of severe complications and deaths is especially high.

prevalence of encephalitis in Russian regions (incidence per 100,000 people)

In nature, the tick-borne encephalitis virus is found in animals and birds - rodents, wolves, moose, large livestock, which serve as a source of food for ticks, infecting them in the process. A person ends up among them by chance, but for a tick it doesn’t matter whose blood it feeds on and to whom it transmits the virus.

There is a pronounced seasonality of the disease, the peak of which occurs in the spring-summer period. The culprits for this are also ixodid ticks, which, after a long winter hibernation, crawl to the surface and begin hunting. Ticks hunt in the literal sense, that is, they wait for the victim and attack.

Hungry ticks prefer to wait for prey in shady bushes or grass, crawling out of the forest floor and spreading upward to a height of up to one and a half meters. This happens if you visit the forest, but you need to remember that the tick itself can “come” into the house: with flowers, branches, clothes, pets, so even a family member who avoids forest walks can suffer.

Thanks to the ability to sense changes in the concentration of carbon dioxide in the environment and thermal radiation, The tick accurately detects the approach of a food source and attacks. Lacking the ability to jump or fly, it clings or falls onto its prey. On the human body, the tick always crawls upward, reaching the thin and delicate skin of the neck, abdomen, chest, and axillary areas. Since the saliva of insects contains substances with anticoagulant and anesthetic properties, the bite may not be noticeable immediately, so it will not be possible to brush it off like a mosquito or midge. Moreover, if females attach themselves for a long period of time, then males do it quickly, so the very fact of a tick bite may go unnoticed, then the cause of the malaise and subsequent development of the disease cannot be immediately established. The female can remain on the human body for many days, and only after being saturated with blood and increasing in weight by several tens, or even a hundred times, does it leave the victim.

The risk group for viral tick-borne encephalitis includes foresters and other workers whose activities involve visiting forests, geologists, road builders, tourists, avid lovers of picking mushrooms and berries, or simply walking and having picnics in nature. In areas where encephalitis is endemic, this may be unsafe.

You can become infected with tick-borne encephalitis not only in the forest, but also in city parks and squares, in gardens and summer cottages. It’s worth remembering this when planning to walk in the shade of trees, even within city limits.

In addition to the vector-borne route of transmission of infection (through an insect bite), cases of infection have been described when consuming raw goat or cow milk. This happens to children who are given raw milk from private farmsteads. Boiling destroys the encephalitis virus, so you should not neglect such a simple procedure, especially when it comes to the little ones.

Features of the course of tick-borne encephalitis

The tick-borne encephalitis virus, having entered the bloodstream, is directed to the nervous tissue, affecting the cerebral cortex, white matter, subcortical nuclei, cranial nerves, spinal roots, causing paresis and paralysis, and changes in sensitivity. Involvement of various brain structures can cause seizures, impaired consciousness up to coma, and cerebral edema. The older the patient, the higher the risk of complications and severe course of the disease, and after 60 years, the likelihood of death is especially high.

Like any other infection, tick-borne encephalitis occurs with a latent period, during which there may be no signs of the disease at all.

Average the incubation period lasts 1-2 weeks, maximum – 30 days, when the infectious agent multiplies intensively in the human body. By the end of the latent course, weakness, weakness, body aches, fever may appear, that is, symptoms characteristic of many infectious diseases, which is why it is so important to establish the fact of a tick bite, because it is not so easy to suspect encephalitis in such cases.

Depending on the predominance of one or another sign of the disease, forms of tick-borne encephalitis:

1. Feverish.
2. Meningeal.
3. With focal damage to nervous tissue.
4. Chronic variants of the course.

The first three forms are classified as acute encephalitis, and the febrile and meningeal varieties account for about 90% of all cases of the disease. Chronic tick-borne encephalitis is diagnosed much less frequently, which can last for years, continuously progressing and leading to persistent neurological disorders.

Without focusing on a detailed description of all possible symptoms of damage to the nervous system, it is worth pointing out development in patients of three main syndromes:

1. General infectious nature.
2. Meningeal.
3. Syndrome of focal pathology of the nervous system.

manifestations of encephalitis

Signs of a general infectious nature are associated with increased reproduction of the virus and its spread not only to the nervous tissue, but also to other parenchymal organs, as well as effects on the walls of blood vessels. Patients experience severe fever with a temperature rise to 39-40 degrees, chills, weakness, pain in muscles and bones, and possible dyspeptic disorders.

Meningeal syndrome associated with damage to the pia mater and increased intracranial pressure. It includes severe headache, nausea, repeated vomiting that does not bring relief, impaired consciousness, photophobia, convulsions, psychomotor agitation.

Focal neurological impairment syndrome is associated with damage to specific parts of the nervous system and is manifested by paralysis, paresis, impaired sensitivity and function of the cardiovascular and respiratory systems, and convulsive syndrome.

Feverish form The disease is characterized by a favorable prognosis and rapid recovery. This is the mildest form of tick-borne encephalitis, proceeding practically without damage to the nervous tissue by the virus. Symptoms boil down to fever, general signs of an infectious process (nausea, weakness, headache). Fever and flu-like changes last for about three to five days, after which recovery begins.

Meningeal variant The course of encephalitis is considered the most common, and manifestations include headache, sore eyes, nausea and vomiting. In addition to the characteristic symptoms, changes in the cerebrospinal fluid can also be detected. Signs of damage to the meninges in the form of stiffness of the neck muscles and other meningeal symptoms can be easily determined by a health worker of any specialty, so diagnosing this form of the disease after a tick bite does not cause great difficulties. The fever lasts about one to two weeks, and then recovery occurs. The meningeal form is considered favorable, although the consequences in the form of headaches can accompany the patient for quite a long time.

A form of tick-borne encephalitis with focal neurological disorders the rarest and, at the same time, the most severe in terms of course and consequences. Mortality with it reaches 40% with the Far Eastern type of infection. With simultaneous damage to the meninges and the substance of the brain (meningoencephalitis), the course of the disease is very severe: fever, nausea and vomiting, headache, convulsions up to epistatus, impaired consciousness in the form of delirium, hallucinations, coma. The recovery process takes up to 2 years or more, and the consequences in the form of paralysis and muscle atrophy last a lifetime.

In addition to the cerebral hemispheres, damage to the brain stem, spinal roots and peripheral nerves is possible. These cases are accompanied by persistent paralysis, severe pain and inevitably lead to serious disorders that turn a previously healthy person into a disabled person, bedridden, unable to move or even speak. Such patients remain deeply disabled and require constant care and supervision, since even eating becomes a problem.

In children, the disease is severe and is more often recorded in boys of primary school age. The forms of infection are similar to those described for adults. Symptoms of brain damage develop rapidly and leave consequences in the form of paralysis, etc. In children, more often than in adults, complications are observed in the form of convulsive syndrome and hyperkinesis - involuntary excessive movements of the limbs, head, torso, which sometimes persist for life. Since a child often does not know about the danger of tick bites, and even more so, does not carefully examine the skin after walking in the forest or park, the task of prevention and timely detection of blood-sucking insects lies with the parents.

Video: consequences of tick-borne encephalitis

Detection and treatment of tick-borne encephalitis

Diagnosis of encephalitis is based on a characteristic clinical picture, data on visits to forests, and the presence of tick bites. Used to confirm the diagnosis laboratory methods, making it possible to detect specific antibodies (proteins) produced in the patient’s body in response to the introduction of the virus. When visiting a doctor, the first thing the patient will be asked to do is donate blood, in which elevated white blood cells and accelerated ESR may be detected, but these changes are nonspecific and accompany many other diseases, which is why it is so important to conduct serological studies to look for antibodies.

No less important is analysiscerebrospinal fluid, in which the content of lymphocytes and protein increases, and its leakage under pressure indicates intracranial hypertension. It is worth noting that it is not always possible to examine cerebrospinal fluid. For example, in coma and dysfunction of the medulla oblongata, this manipulation is contraindicated, and doctors are forced to wait for the patient’s condition to stabilize. At the same time, with a relatively mild febrile form of the disease, there are no changes in the cerebrospinal fluid, and diagnosis is based on the search for antiviral antibodies.

Can bring invaluable benefits mite analysis for the presence of tick-borne encephalitis virus in it, which is why it is so important not only to remove it when detected on the body, but also to preserve it and transfer it to the appropriate laboratory. If fears regarding tick infection are confirmed, then it is possible to prevent the disease in advance and begin treatment as early as possible.

Treatment of tick-borne encephalitis requires mandatory hospitalization in the intensive care unit. Patients are prescribed strict bed rest with minimization of all kinds of irritants. A balanced diet plays an important role, especially since the infection is often accompanied by dysfunction of the digestive system.

Prescribed therapy includes:

Video: what to do after suffering from encephalitis?

Prevention of tick-borne encephalitis

The rule “a disease is easier to prevent than to treat” works very well in relation to tick-borne infections, and therefore preventive measures are of paramount importance in areas where the disease is spreading.

Prevention of tick-borne encephalitis includes nonspecific measures that it is advisable to observe and know for those who live in dangerous areas and visit tick habitats. Specific prevention consists of using vaccines according to developed schemes.

When visiting forests and other tick habitats, you need to follow simple rules:

1. Clothing should be as closed as possible, overalls are preferred, a scarf or cap is required, and it is better to protect the neck and head with a hood. The collar, sleeve cuffs, and socks should fit snugly to the surface of the skin. If possible, you should wear light-colored and plain clothes so that in the event of a tick attack, it will be easier to notice. At home, clothes should be shaken out and it is advisable to leave them away from living quarters;
2. It is useful to examine the skin as often as possible, not only yourself, but also ask others, because the scalp, back, and back of the neck are quite problematic to carefully examine even with the help of a mirror;
3. Plants and other objects brought from the forest may well become a source of ticks for all family members, so it is better to avoid such “souvenirs”. Pets should also be examined, because they too can become victims of “bloodsuckers”;
4. If you need to spend the night in the forest, it is better to choose places without grass, open areas with sandy soil, to minimize the likelihood of a tick attack;
5. The use of repellents applied to the skin, as well as acaricides for treating clothing, helps protect against insects, so do not neglect this method of prevention. Children should be handled by adults, and when walking with kids, you need to take into account their tendency to put their fingers in their mouths, so it is better to leave their hands untreated.

If a tick does attack, you need to remove it correctly or contact a medical facility.(trauma center, ambulance station). At home, to remove the “bloodsucker,” the bite site should be lubricated with vegetable oil, and the tick should be grabbed with tweezers or a thread, tied around the neck, while making rocking movements, as if twisting the insect from the skin. It happens that when you try to remove a tick, its body comes off, but the head remains in the skin. In such cases, you should immediately contact a specialist, as the risk of infection remains.

infographic: Belta

Specific prevention of tick-borne encephalitis consists of vaccination of the population of areas where the disease is endemic, as well as visitors. Among local residents, the proportion of vaccinated people should not be lower than 95%, and special attention is paid to people whose professional activities involve staying in tick habitats.

The standard of vaccination is to administer the drug twice, followed by revaccination once a year. The effect will be if vaccination is carried out at least two weeks before leaving for an endemic focus or before the start of the epidemic season. Vaccination against tick-borne encephalitis can be done either urgently in case of a tick bite, or routinely according to a standard regimen, which involves at least one revaccination. Emergency prevention is carried out on the first day after an insect bite.

In addition to tick-borne encephalitis, there are, although much less frequently, secondary inflammatory processes in the brain that complicate the course of other diseases - tumors of the hematopoietic system, sepsis, measles and chickenpox, and traumatic injuries. Approaches to therapy for such conditions are determined by the nature of the underlying disease and symptoms of brain damage.

In case of tick-borne infections, vigilance and caution when visiting the habitats of blood-sucking insects, timely detection and removal of the tick, vaccination and early contact with specialists can significantly reduce the risk of infection, as well as improve the results of therapy in the development of encephalitis.

Video: encephalitis in the program “Live Healthy!”

One of the presenters will answer your question.

Currently answering questions: A. Olesya Valerievna, Ph.D., teacher at a medical university

Polydystrophy. Polydystrophy, or Alper's disease, refers to a heterogeneous group of degenerative diseases of the cerebral cortex that develop during the neonatal period or early childhood. Pathological changes in the brain are nonspecific; diffuse neuronal loss and gliosis occur in the cerebral cortex and cerebellum. Recurrent seizures and dementia are the most common. The disease in subsequent children indicates its inheritance in a recessive manner. This group also includes previously considered congenital metabolic diseases. In some cases, lactic acidosis is detected, secondary to a deficiency of the enzyme in combination with pyruvate dehydrogenase. In other patients, liver cirrhosis progresses. For polydystrophy accompanied by lactic acidosis, a temporary effect is obtained by treatment with corticosteroids or by following a ketogenic diet.

Lee's disease. Subacute necrotizing encephalomyelopathy is a disorder of metabolic processes in the brain, leading to diffuse damage, especially in the brainstem area.

Anatomical changes consist of degeneration of neural structures of the brain and proliferation of capillaries with their characteristic distribution around the third ventricle, aqueduct and fourth ventricle. The pathological picture is similar to that of encephalopathy caused by thiamine deficiency. It is possible that the disease is secondary to a congenital disorder of thiamine metabolism.

The child usually falls ill during the neonatal period; in: subacute course, the disease is manifested by vomiting, loss of body weight, development of paresis, seizures and stupor; with a more sluggish course, mental retardation, decreased visual acuity and dementia are noted. Nystagmus and paralysis of the external muscles of the eye are often associated. It is possible to develop both spastic and flaccid paralysis. In an advanced stage, irregular breathing appears, periodic hyperventilation develops and further apnea occurs. Periods of exacerbation, often followed by periods of remission, are differential diagnostic features. Death may occur within a few weeks of the onset of the disease, or the child may live for several years. The recommended treatment with large doses of thiamine is not accompanied by convincing results.

Curly hair disease. Menke syndrome is caused by a disorder of copper metabolism, in which pronounced degenerative changes occur in the brain and arterial vessels, leading to the death of the child.

Anatomically, diffuse degenerative changes in the brain are observed with the disappearance of cortical neurons, gliosis and cystic degeneration of the most affected parts. Extensive changes in arterial vessels consist in the fact that their elastic layer is fragmented and the intima thickens. The underlying pathology is increased copper binding to certain tissues, including fibroblasts and the small intestinal mucosa. The binding of copper by the lining of the small intestine explains the decrease in its absorption and level in the blood and leads to a decrease in the synthesis of ceruloplasmin.

Along with inadequate weight gain and hypothermia observed immediately after birth, the baby develops sepsis extremely often. Initially, normal hair on the head becomes sparse and brittle. Under a microscope they appear curved. Often a child suffers from seborrheic dermatitis. Already in the first few months of life, a pronounced mental retardation becomes apparent, often accompanied by seizures. Most children die within the first year of life.

The diagnosis is confirmed using laboratory data. X-rays of long bones reveal changes similar to those of scurvy. The amount of copper and ceruloplasmin in the blood decreases. Parenteral administration of copper preparations even to children in the first months of life does not prevent the development of brain disorders.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Classification

Depending on the extent of the pathological process, there are:

• Limited (there is a specific focus).
• Diffuse (widespread) - inflammation to one degree or another affects the entire spinal cord.
• Multifocal - more than 2 foci are observed in different areas.
• Transverse myelitis occurs when inflammation affects several adjacent segments.

• bacterial;
• viral;
• traumatic;
• toxic;
• post-vaccination;
• radial;
• idiopathic (when the cause cannot be determined).

Causes of myelitis of the spinal cord

• Bacterial myelitis (infectious myelitis) occurs with purulent meningitis. The most common causative agent of inflammation is meningococcal infection. Also, this type of myelitis can be caused by treponema pallidum (in severe forms of syphilis), the causative agents of diseases such as brucellosis, typhoid fever and measles. A pathogenic microorganism can enter the spinal cord either through a spinal injury or through the bloodstream from another source of infection in the body.
• Viral myelitis occurs in 20-40% of cases of spinal cord inflammation. The most common viruses that are isolated during the disease are the Coxsackie group viruses, ECHO, rabies virus, influenza virus, etc.
• Traumatic myelitis occurs with closed or open spinal injuries, which are accompanied by a bacterial or viral infection.
• Toxic myelitis caused by poisoning with chemicals such as mercury, lead, etc. Often, in addition to the symptoms of inflammation of the spinal cord, there is also a clinical picture of damage to the spinal roots and nerves.
• Post-vaccination myelitis has an allergic nature, developing after vaccination in sensitized individuals (predisposed to this kind of complications).
• Radiation myelitis most often develops during radiation therapy of malignant tumors of the esophagus, larynx, pharynx, as well as during irradiation of metastases in the retroperitoneal lymph nodes.
• Acute idiopathic transverse myelitis occurs when it is not possible to find the cause that caused the inflammation. In this situation, the main role in the occurrence of the disease is given to the immune system, the occurrence of a malfunction in which leads to an “attack” of the brain tissue by its own cells.

Main symptoms

Further manifestations will depend on the type of disease.

Acute focal myelitis

Acute disseminated (widespread) myelitis

Subacute and chronic myelitis

Following the pain syndrome, sensory disturbances and paralysis develop, and the functioning of the pelvic organs suffers. Paralysis at the beginning of the disease is sluggish, but gradually spasm appears and pathological reflexes arise.

Very often, with subacute and chronic myelitis, blood supply and tissue nutrition are disrupted, as a result of which bedsores quickly form.

Stagnation of urine in the urinary organs, as well as bedsores, can serve as an entry point for infection, resulting in blood poisoning.

Radiation myelitis

Course of the disease

Diagnostics

Treatment of myelitis

• Hospitalization in a hospital is required.
• Allergic, viral and idiopathic forms of the disease require the administration of large doses of hormonal drugs (up to 120 g of prednisolone per day). The duration of such treatment depends on the rate of improvement.
• From the first days of treatment, antibiotics are prescribed, even if no bacteria were found in the cerebrospinal fluid. This is a necessary measure to prevent the development of superinfection (secondary infection). Antibacterial agents are prescribed in the maximum permissible doses.
• Diuretics (Furosemide, Mannitol, etc.).
• When urinary retention occurs, constantly empty the bladder to prevent stagnation of urine.
• Skin care to prevent bedsores.
• For severe pain, narcotic or non-narcotic analgesics are prescribed.
• When body temperature rises above 38.5 o C, antipyretics are given.
• After the acute process subsides, vitamins are prescribed, and rehabilitation measures are carried out: physical therapy, massage, physiotherapeutic procedures.

Myelitis in dogs

Manifestations depend on the severity of the disease and the extent of brain damage. The disease begins with changes in gait and seizures. Then paralysis of the hind limbs is observed, bedsores form due to immobility, and the animal dies.

Treatment. The dog is placed on a soft bedding and periodically turned over to prevent the formation of bedsores. Physiotherapy procedures are performed on the lumbar region: Solux, UHF, dry heat. A massage of the hind limbs is prescribed. For paralysis - strychnine and dibazole. If bowel movement is impaired, a cleansing enema is done every few days.

It is called myelitis (from the Greek "myelos"). It is the human body’s immune response to an infectious attack, intoxication or traumatic cellular destruction of nervous tissue. Depending on the width of the lesion and location, the disease can interrupt the body's communication with the brain or permanently impair the control of the limbs and the functioning of internal organs.

Reasons for appearance

Varieties of myelitis are divided into two main groups, which are formed based on the order of occurrence of the lesion process:

• Primary. Pathology is the result of a direct lesion (infection, patient.
• Secondary. The disease develops against the background of another disease or is its complication (that is, a consequence of secondary infection).

There is simultaneous inflammation of the brain and spinal cord.

Classification

There is a classification according to the mechanism of occurrence of the inflammation process. Depending on this, myelitis is divided into the following categories:

• traumatic;
• infectious;
• idiopathic (etiology unclear);
• intoxicating.

Infections of an infectious nature are produced predominantly hematogenously, through the blood supply (the only exception is infection in an open wound). The method of penetration of viral infections in primary type myelitis involves the direct entry of viruses through the bite of infected people and animals, blood-sucking insects, or unsterile medical instruments into the blood. The most likely causative agents of infectious primary myelitis are neurotropic (having the ability to penetrate neurons) viruses of tetanus, influenza, measles, chickenpox, rabies, mumps, lichen, polio, various types of herpes (cytomegalovirus, herpes simplex, Epstein-Barr). How else does inflammation of the spinal cord occur?

Provoking factors of secondary type infection

Foci of infection of a secondary type appear in the spinal cord also as a result of the movement of bacteria through the blood supply. The following pathogens are known:

Traumatic sources of inflammation:

• irradiation (high-energy radiation);
• electric shock;
• decompression sickness.

Metabolic disorders:

• percinous anemia (neuron death, demyelination, vitamin B12 deficiency); diabetes;
• chronic liver diseases.

In addition to the factors listed above, the inflammatory process in the spinal cord can be provoked by toxic substances (including anesthesia during spinal surgery), collagenosis (connective tissue diseases), heavy metals, inflammation of the meninges (arachnoiditis), and autoimmune diseases.

Inflammation of the spinal cord can be caused by the administration of a vaccine for any of the viral diseases listed above.

Features of development

The infection enters the spinal cord from the outside either hematogenously or lymphogenously from the primary focus (with lymph or blood). The second route of introduction is either the fibers of the spinal cord nerves.

First, the space between and under the membranes becomes infected, then the main brain tissues (white and gray matter) are affected.

The spinal cord is divided into segments that correspond in size to the vertebrae. Each segment is responsible for reflexes and transmits signals from a specific muscle group or internal organ to the brain and back. Myelitis, depending on the number of infected segments, is defined as limited (localized), distributed among segments (disseminated) or focal (in unrelated or adjacent segments). Opticomyelitis is distinguished separately when transverse myelitis and optic neuritis, which is characterized by demyelination, are combined.

By localization

Based on localization in the brain stem, myelitis is divided into:

• transverse (the affected area is the white and gray matter of the brain in a number of segments at once);
• anterior (affected area - white matter in the area of ​​the median anterior groove);
• peripheral (affected on the sides and back of the brain);
• central (gray matter is affected).

The source of inflammation of the gray matter of the spinal cord is the response of the immune system to the presence of a pathogenic factor.

By intensity

The disease according to the intensity of the reaction is defined as:

The main result of the activity of immune cells is neuronal degeneration and demyelination of the closest conducting nerves, which are involved in the inflammatory process. Necrotization of nerve tissue manifests itself in the form of an increase in fragments of cell structures in the cerebrospinal fluid.

Inflammation of the spinal cord is expressed in the form of swelling, tissue swelling, and a blurred boundary between the white and gray matter (visible on MRI). If you zoom in a lot, you can see blood clots in the capillaries, microscopic hemorrhages, destruction of cell walls, and disintegration of the neuronal myelin sheath.

The disease most often (about 40% of cases) affects the thoracic vertebral region and the lower part of the spinal column. In terms of frequency of infection, the second place is the upper half of the chest, lower back and thoracic-lumbar junction. The neck region is rarely infected. Most often, adjacent pairs of vertebrae or several sections are affected (disseminated inflammation).

Symptoms and treatment of spinal cord inflammation are interrelated.

Symptoms

The symptoms of myelitis vary clinically. Their severity is determined by the degree and level of inflammation of the spinal cord. The main ones are the following:

• sensory defects;
• unpleasant sensations of pain;
• dysfunction of the pelvis;
• paralysis.

The first symptoms of inflammation of the spinal cord are similar to the signs of any infectious process: general weakness, chills, increased body temperature up to 39˚. The presence of neurological pathology is indicated by back pain that can spread to neighboring tissues from the affected area.

Severely developed inflammation of the spinal cord substance leads to loss of sensory and motor functions.

Diagnostic features

An infectious origin can be recognized by characteristic signs, as confirmed by neurological tests. To identify less pronounced chronic and subacute forms, you can use imaging diagnostic methods.

Computed tomography using a contrast agent or magnetic resonance imaging are the leading imaging methods. In addition, myelography (a less effective type of fluoroscopy) is used.

How is the pathogen determined?

The infectious pathogen is determined through bacteriological analyzes of CSF, studies of exudates and blood in the affected area. Spinal cord fluid samples are tested for lymphocyte counts, protein content, and physical changes. If there are large numbers of neutrophils, this indicates the severity of the pathology.

Tests and symptoms may indicate diseases similar in mechanism to multiple sclerosis, epiduritis (epidural purulent abscess), arachnoiditis, polyneuropathy, encephalomyelitis. With the help of differential it is clarified.

Treatment

It is advisable to treat spinal cord inflammation in an inpatient setting or under constant medical supervision. The correct position of the human body in bed and continuous care will ensure minimal tissue and skin damage, since myelitis often causes trophic disorders, which, in turn, provoke the development of bedsores in the patient.

Inflammatory processes become stable and are reduced through hormonal medications (corticosteroids). Bactericidal and antiviral treatment (antibiotics, sulfonamides, immunostimulating agents) ensures accelerated destruction of the infectious pathogen.

To prevent the occurrence of bedsores, procedures are regularly done to improve trophism and blood circulation: ultraviolet irradiation, bandages with healing ointments, washing the skin with potassium permanganate.

When gangrenous lesions appear, therapy involves surgical intervention (necrotic tissue is excised).

If there are defects in the functioning of urination, a catheter is placed in the victim. To prevent diseases of the urinary system, regular rinsing with an antiseptic is performed. Stimulants help the patient strengthen degrading muscle tissue. High tone and muscle contractures in spastic paralysis are softened with muscle relaxants. Thanks to the use of anticholinesterase drugs, conductivity in motor neurons of excitation nerves improves.

Gymnastics and massage

Careful gymnastics, as well as massage, improve muscles and reduce tension in the ligaments during inflammation of the spinal cord roots. During the recovery period after stabilization of motor defects, the patient is recommended to do exercises to restore the elasticity and mobility of the ligaments.

Restorative complex treatment of inflammation of the spinal cord involves physiotherapy: electrophoresis with biologically active substances and drugs, electrical stimulation in the spinal region. In addition, balneological procedures (mud treatment, mineral baths) are desirable.

Determining the prognosis of the pathology is influenced by many factors: the condition and age of the patient, the type of disease (secondary or primary, accompanied by other neurological disorders), the occurrence of the inflammatory process and infection. Positive dynamics prevail in the overall statistics.

Disease prognosis

In case of inflammation of the spinal cord, its prognosis is determined by the location of the pathology, its form and severity. As a rule, doctors give a sharply negative prognosis only for the meningococcal type of infection. Other varieties can be treated quite effectively.

The recovery process after inflammation of the spinal cord can take a long period. The patient is given a non-working second disability group with medical recertification every year. It is believed that complete restoration of mobility of the lower extremities after spinal cord myelitis is possible literally 6-8 months after the onset of the disease. With a transverse lesion of the spinal cord of a stroke-like nature, paraplegia and paralysis may persist. It can also end in absolute recovery.

With a similar frequency, there are cases that are accompanied by a gradual progression of symptoms, ultimately ending in the death of the patient over 5-6 years. The most unfavorable prognosis is if the inflammatory focus is localized in the lumbosacral region. There is also a certain danger if the cervical spine is affected.

The highest probability of a patient’s recovery after myelitis is observed with timely medical care. When a patient consults a doctor at the stage of loss of sensation in the limbs, the possibility of full recovery will be significantly reduced.

We now know what inflammation of the spinal cord roots is called.

Prevention

Currently, people are being vaccinated, which protects them from infectious pathologies that affect the membranes of the brain and spinal cord:

• poliomyelitis - infection of the motor function of the cervical spine;
• measles is a disease whose symptoms are a rash in the mouth and skin, cough;
• Mumps is a virus that affects the salivary glands.

All other causes of the disease are difficult to predict and impossible to prevent. The most important thing is to be attentive to your own health; if something bothers you, you need to seek help from doctors in a timely manner and not self-medicate.

We looked at the symptoms and treatment of spinal cord inflammation.