Acute necrotizing hemorrhagic encephalomyelitis

Introduction to acute necrotic hemorrhagic encephalomyelitis Acute necrotic hemorrhagic encephalomyelitis, also known as Weston-Hurst acute hemorrhagic leukoencephalitis, is an acute demyelinating disease that occurs in young adults and can also affect children. It is considered to be acute disseminated encephalomyelitis. The violent hairstyle, the clinical process is extremely urgent, the condition is dangerous, and the mortality rate is high. The patient presented with acute fever, headache, stiff neck, mental disorder and coma, and many cases died within 2 to 4 days or even hours. basic knowledge The proportion of illness: 0.005% Susceptible people: youth and children Mode of infection: non-infectious Complications: urinary tract infections acne

Causes of acute necrotic hemorrhagic encephalomyelitis

(1) Causes of the disease

The etiology of acute necrotic hemorrhagic encephalomyelitis is unclear, but similar to other demyelinating lesions.

(two) pathogenesis

The disease is similar to the histological changes of acute disseminated encephalomyelitis, supporting the same basic pathological processes in both related diseases. Behan et al found that patients with encephalomyelitis and acute necrotic hemorrhagic encephalitis The fact that cells can be converted to primitive lymphocytes by reaction to pure brain-derived myelin basic protein further supports that the pathogenesis of both diseases may be delayed allergic reactions, and Waksman and Adams have demonstrated experimental allergic reactivity. Vascular lesions in encephalomyelitis can be converted to vascular lesions of necrotizing encephalomyelitis by inducing the Schwantzman response (intravenous injection of meningococcal toxin), and a small number of patients recovering from typical necrotizing encephalitis later develop into typical MS.

Pathological findings have a unique feature. On the brain slice, it can be seen that one or both sides of the cerebral hemisphere white matter is destroyed to almost liquefy, mainly affecting the bilateral frontal lobe, and the affected tissue is pink or gray-yellow mixed with multiple small hemorrhage. Spots, the same changes are common in the brainstem and cerebellar arm, occasionally in the spinal cord, histological examination found extensive small blood vessels and perivascular brain tissue necrosis, accompanied by a large number of cell infiltration, multiple small lesions and varying degrees of meningitis The pathological features of the lesions distributed around the blood vessels are similar to those of disseminated encephalomyelitis. The difference is that the extensive necrosis and the lesions in the cerebral hemisphere tend to form large lesions, and the lesions of the blood vessels cause fibrin to ooze out to the blood vessels. Wall and surrounding tissue.

The same necrotizing lesion can occur in the spinal cord, and it is entirely possible to show fulminant myelitis, but this speculation is difficult to confirm by pathology.

Acute necrotic hemorrhagic encephalomyelitis prevention

There is no effective prevention method for autoimmune diseases, and prevention of infection, cold, and complications are important contents of clinical medical care.

Acute necrotic hemorrhagic encephalomyelitis complications Complications, urinary tract infection, acne

Should pay attention to secondary lung infections, urinary tract infections, hemorrhoids and so on.

Acute necrotic hemorrhagic cerebrospinal inflammation symptoms common symptoms hyperthermia coma quadripleen encephalitis-like changes

The disease is similar to the histological changes of acute disseminated encephalomyelitis. There are almost no exceptions (1 to 14 days) with a history of prodromal infections, sometimes mycoplasma pneumonia, and more often the cause cannot be determined. Symptoms of nervous system, sudden onset of headache, high fever, neck stiffness and confusion, followed by signs of transient one or both sides of the cerebral hemisphere and brain stem, such as focal seizures, hemiplegia, quadriplegia, pseudo Medullary paralysis and progressive deepening coma.

CSF pressure increased, the number of cells increased, EEG diffuse slow activity, CT sees the brain, brain stem and cerebellar white matter irregular low-density area.

Examination of acute necrotic hemorrhagic encephalomyelitis

1. Blood routine often has leukocytosis, sometimes up to 30 × 109 / L.

2. ESR increases.

3. CSF pressure increased in cerebrospinal fluid, the number of cells from several lymphocytes to multinucleated cells proliferated, up to 3 × 109 / L, the number of common red blood cells, protein content increased, but the sugar content is normal.

4. CT and MRI scans show that ac large white matter lesions are conducive to diagnosis.

Diagnosis and differentiation of acute necrotic hemorrhagic encephalomyelitis

The rapid development of "encephalomyelitis" in young people should consider this disease, CT and MRI scans are conducive to clinical diagnosis, and brain biopsy pathology can help diagnose.

The disease should be differentiated from brain abscess, subdural hematoma, focal thrombotic brain softening and acute encephalitis caused by herpes zoster or other viral infections.

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