acute myelitis Acute transverse myelitis refers to acute inflammatory changes in the spinal cord caused by various autoimmune reactions, also known as acute transverse myelitis, which is the most common type of myelitis in clinical practice. This condition represents an acute non-specific inflammatory lesion of the spinal cord, often triggered post-infection (occasionally post-vaccination), with pathological changes including spinal cord swelling, congestion, axonal degeneration, inflammatory cell infiltration, and in severe cases, spinal cord softening and necrosis.

Acute transverse myelitis refers to acute transverse inflammatory changes in the spinal cord caused by various autoimmune reactions. It is also known as acute transverse myelitis and is the most common type of myelitis in clinical practice. This condition represents an acute non-specific inflammatory lesion of the spinal cord, often triggered by infections (occasionally following vaccination). Pathological changes include spinal cord swelling, congestion, axonal degeneration, and infiltration of inflammatory cells, with severe cases showing spinal cord softening and necrosis. The most commonly affected segment is the upper thoracic spinal cord, leading to corresponding motor and sensory impairments below the level of the lesion, as well as dysfunction of bladder and bowel control. In some cases, the cervical spinal cord may be involved, causing respiratory muscle paralysis and potentially endangering the patient's life.

Most patients experience symptoms related to upper respiratory tract infections or diarrhea within 1-2 weeks before the onset of spinal cord symptoms, or have a history of viral infections or vaccination. However, viral antibodies are not detected in the cerebrospinal fluid of these patients, and no viruses are isolated from the spinal cord or cerebrospinal fluid. Based on this, researchers speculate that the body's autoimmune response following viral infection may cause acute non-specific damage to the spinal cord, which may be the main pathogenic mechanism of this disease.

Motor impairment

Paraparesis or paraplegia due to upper thoracic cord involvement is common. If the cervical cord is affected, quadriplegia and even respiratory muscle weakness can occur.

The early stage is characterized by "spinal shock," presenting as flaccid paralysis with decreased muscle tone, often accompanied by the disappearance of deep reflexes such as the knee jerk reflex.

2-4 weeks later, it progresses to spastic paralysis with increased muscle tone, hyperactive or exaggerated deep reflexes, and the potential appearance of pathological reflexes. During this phase, muscle strength remains at a relatively low level, with possible partial recovery compared to the initial stage.

Complete recovery of muscle strength generally takes several weeks to months, and some cases may have residual symptoms and signs.

In severe cases or with complications such as urinary tract infections or pulmonary infections, the "spinal shock" phase and the entire course of the disease may be prolonged. At this stage, there is increased flexor muscle tone in the limbs, with spasms upon slight stimulation, accompanied by symptoms such as sweating, piloerection, and urinary and fecal incontinence, known as autonomic dysreflexia. These conditions often indicate a poorer prognosis.

Sensory impairment

Below the level of the spinal cord lesion, there may be diminished or absent superficial (touch, pain, temperature) and deep (proprioception, vibration) sensations, with the potential development of a zone of sensory hypersensitivity at the upper border of the affected level.

During the recovery phase, the sensory level gradually descends, but the recovery of sensory function is slower and less complete compared to motor function.

Autonomic nervous system dysfunction

Early manifestations include urinary retention, with bladder distension reaching up to 1000ml, leading to involuntary overflow of urine upon overdistention, along with potential constipation and decreased or absent sweating in the body below the level of the lesion.

As spinal cord function gradually recovers, reflex neurogenic bladder may appear, characterized by bladder contraction with a small amount of urine, leading to involuntary urination. This may be accompanied by fecal incontinence, piloerection, sweating, and some improvement in skin temperature.

Skin care

Maintain skin hygiene, reposition regularly, and use air cushions at the sacrum, heels, and bony prominences to prevent pressure ulcers. When the skin becomes red, gently rub with 10% alcohol to promote blood circulation. If pressure ulcers occur, apply local dressing to promote healing and avoid using hot water bags to prevent burns.

Prevention and treatment of aspiration pneumonia

Ensure warmth, encourage coughing, perform percussion and postural drainage, and assist with changing body positions to facilitate sputum clearance.

Prevention and treatment of urinary tract infections

For those with severe urinary retention, sterile catheterization with a closed drainage system should be considered, with regular emptying of the bladder. For those with urinary and fecal incontinence, frequent diaper changes and perineal hygiene are important.

Patients with this condition should pay attention to the following issues in their daily lives:

Dress appropriately according to the season and climate to prevent colds and infections.

After discharge, strictly follow the medical advice regarding medication, and avoid missing doses, self-discontinuation of medication, or altering the dosage without medical consultation.

Emphasize the importance of rehabilitation training.

Routine prevention: Since the exact cause of this condition is unknown, there are no direct and effective preventive measures. However, paying attention to avoiding triggering factors in daily life, such as strengthening exercise to enhance immunity and preventing exposure to cold and colds, may have some significance in preventing this disease.