Synonyms.—Myelitis; Acute Diffuse Myelitis; Transverse Myelitis; Spinal Malacia.
Definition.—An acute inflammation of the spinal cord, extending transversely or longitudinally, and attended by softening or sclerosis of the cord.
Etiology.—The disease occurs more frequently in men than in women, probably due to greater exposure of the former. Exposure to wet and cold, especially in alcoholics, may be followed by myelitis, and it frequently follows the infectious fevers, especially small-pox, typhus fever, and measles. Traumatism of the spine, caries of the bones, great emotional excitement, and certain mineral poisons, especially lead, arsenic, mercury, and phosphorus, may induce it. Gout, rheumatism, and syphilis not infrequently precede myelitis, though syphilis is more apt to give rise to the chronic form,
Pathology.—The lesion is most frequently found in the upper dorsal region, next in the cervical, and rarely in the lumbar region.
The disease may be limited to a small vertical area extending entirely across the cord—transverse myelitis—or a large portion may be affected—diffuse myelitis; again several areas may be involved in different parts of the cord, when it is termed disseminated myelitis, and is known as central myelitis when only the gray matter is involved.
Upon ocular inspection the cord may present no visible changes, or it may show extreme softening, almost diffluent, or it may be sclerotic, owing to proliferation of interstitial connective tissue.
The cord may be swollen, and red, gray, or yellow in color, according to tht amount of blood, connective tissue, or fat contained.
Symptoms.—The symptoms will naturally depend upon the location and extent of the lesion. The most frequent seat of election is the dorsal region, and transverse myelitis is the most common type.
The attack may resemble the first stage of rheumatic fever, beginning with a well-marked chill, rapidly followed by febrile reaction; there is headache, backache with general muscular soreness, nausea, vomiting, and sometimes convulsions. In a few days, however, the spinal symptoms appear, paralysis of motion with complete loss of sensation below the site of the lesion, rapidly develop, incontinence of the sphincters of the bladder and rectum follow, and bed-sores over the sacrum and hips appear.
When the cervical region is involved, the onset may occur suddenly, as noted in the dorsal region, or the attack comes on more insidiously. The upper extremities are now involved, and respiration is disturbed. If very high up, death early ensues owing to failure of respiration.
The sensory symptoms are at first a tingling, crawling, or burning sensation, to be followed shortly by entire loss of sensation. The reflexes may be permanently lost, or they may return in an exaggerated form. Superficial ulceration occurs most frequently when the lumbar region is involved. The course of the disease depends upon the extent and cause of the disease.
Complications and Sequela.—Cystitis occurs as the most frequent complication, and is usually due to retention of urine. Pulmonary and renal complications are common, and amyloid degeneration of the kidneys is sometimes found.
Diagnosis.—The sudden onset of the disease, with early development of paraplegia, paralysis of the sphincters, loss of sensation, absence' of muscular pains, and the rapid trophic changes, make the diagnosis comparatively easy.
Prognosis.—Since secondary changes are very likely to occur in the cord, complete recovery is rare, more or less paraplegia remaining. Where trophic changes are marked, the outlook is unfavorable, and, in some severe, acute cases, death may take place in three or four days. Prolonged high temperature is also unfavorable. When syphilis is responsible for the lesion, the prognosis is more favorable.
Treatment.—In the acute state, treatment will be the same as that for acute meningitis; namely, aconite and gelsemium for the febrile condition and irritation of the cord. Rhus tox. will also be found useful, the indications being the same as for other lesions; namely, sharp stroke of the pulse, starting in the sleep, and general restlessness.
For severe sacral or lumbar pains, with muscular twitchings, full doses of gelsemium with rhamnus Californica or macrotys should be given, thus:
|Macrotys||1 dram each.|
|Water||4 ounces. M.|
Sig. Teaspoonful every hour.
Owing to the tendency to trophic changes, care must be taken to allow no local applications to be made along the spine, after the acute stage has passed, that would tend to injury of the skin. In fact, even in the acute stage, local measures should be confined to soothing measures rather than irritants. The bladder should be catheterized at regular intervals where there is loss of control of the sphincters. Care should be taken to have the catheter aseptic.
After the acute stage has subsided, massage, electricity, and a general tonic treatment will be found useful. Strychnia, iron, and the hypophosphites, or the old Aitkin Comp. tonic mixture—the triple phosphate of iron, quinia, and strychnia—can be used with advantage.
Specific belladonna must not be overlooked, where there is capillary congestion of the cord. It will be given in the usual small dose, ten drops to four ounces of water, a teaspoonful every one, two, or three hours.