Urinary retention

Introduction Autonomic dysfunction is a symptom of acute myelitis, which is characterized by early urinary turbulence, no bladder filling, a tension-free neurogenic bladder, and excessive filling of bladder incontinence; with recovery of spinal cord function, bladder The volume is reduced, and when the urine is filled to 300-400 ml, the patient urinates spontaneously, which is called a reflex neurogenic bladder. Acute myelitis is a non-specific inflammation that causes demyelinating or necrosis of the white matter of the spinal cord, leading to acute transverse spinal cord injury, also known as acute transverse myelitis, with limb paralysis, conduction beam dysfunction, and urinary dysfunction For clinical features.

Cause

The cause of the disease is unclear, including different clinical syndromes, such as post-infectious myelitis and post-vaccination myelitis, demyelinating myelitis (acute multiple sclerosis), necrotizing myelitis, and paraneoplastic myelitis . Most patients have symptoms of upper respiratory tract infection, fever, diarrhea and other viral infections 1-4 weeks before the onset of spinal cord symptoms, but no antibodies are detected in the cerebrospinal fluid, and no virus is isolated from the spinal cord and cerebrospinal fluid, which may be related to allergic reactions after viral infection. Caused by direct infection, it is non-infectious inflammatory myelitis.

an examination

Related inspection

Ultrasound examination of the bladder

1, acute transverse myelitis acute onset, often developed from a few hours to 2-3 days to complete paraplegia. Can occur at any age, young adults are more common, no gender differences, scattered disease. There are fevers, general malaise or symptoms of upper respiratory tract infections for several days or 1-2 weeks before the illness, and there may be incentives such as overwork, trauma and cold. Symptoms are mostly numbness of the lower extremities, banding or root pain of the lesions, and then develop into complete transverse damage of the spinal cord, the chest bone is most often involved. Exercise, sensation, and autonomic dysfunction below the lesion level.

(1) dyskinesia: early common spinal shock, showing paraplegia, limb and tension and sputum reflex disappeared, no pathological signs. The shock period is mostly 2-4 weeks or longer, and the spinal cord injury is severe, and the complications of pulmonary and urinary tract infections and acne are longer. During the recovery period, the muscle tension gradually increased, the sputum reflex was hyperthyroidism, pathological signs appeared, and the limb muscle strength gradually recovered from the distal end.

(2) Sensory disturbance: All the feelings below the lesion segment are missing. At the upper level of the sensory disappearance level, there may be a hypersensitivity zone or a band-like sensory abnormality. The sensory plane gradually declines with the recovery of the disease, but the recovery of the motor function is slower.

(3) autonomic dysfunction: early urinary turbulence, no bladder filling, a tension-free neurogenic bladder, excessive bladder filling filling urinary incontinence; with recovery of spinal cord function, bladder capacity shrinks, urine filling Autonomously urinating at 300-400 ml, called a reflex neurogenic bladder. No sweat or sweat, skin desquamation and edema, loose stents and hyperkeratosis below the lesion plane.

2. The onset of acute ascending myelitis is rapid. The lesions rise rapidly within a few hours or 1-2 days. The lower limbs quickly spread to the upper limbs or the medulla oblongata muscles, causing dysphagia, dysarthria, respiratory muscle spas, and even death. .

3, demyelinating myelitis mostly acute multiple sclerosis (MS) spinal cord type, clinical manifestations and post-infection myelitis similar, but the progress is slow, the disease often peaks within 1-3 weeks. The infection in the anterior region may not be obvious, mostly incomplete transverse injury, showing weakness or paralysis of one or both lower limbs, with numbness, no obvious level of sensory disturbance or two planes, and urinary dysfunction. Evoked potentials and MRI examinations may reveal lesions in other parts of the CNS.

Differential diagnosis

Identification with the following diseases that cause acute limb paralysis:

1. Acute epidural abscess: Acute spinal cord transverse injury may occur. There are often purulent infections in other parts of the body before the disease. The pathogens spread to the epidural space through the blood or adjacent tissues to form an abscess. Sudden onset after a few days or weeks of primary infection, headache, fever, weakness and other symptoms of infection, often accompanied by root pain, spinal pain. Peripheral blood leukocyte count increased, spinal canal obstruction, CSF cell number and protein content increased significantly, CT, MRI is helpful for diagnosis.

2. Column tuberculosis or metastatic tumor: can cause bone destruction and collapse of the vertebral body, and acute transverse damage of the spinal cord. Spinal tuberculosis often has low-heat, anorexia, weight loss, wilting, fatigue and other systemic symptoms and other tuberculosis lesions. The lesions of the spine are prominent or kyphosis. The vertebral body is seen on the spine, the intervertebral space is narrowed and the paravertebral space is seen. Typical changes such as cold abscess shadows. Specific tumors are more common in the elderly, and vertebral destruction can be seen on the X-ray. If the primary lesion is found, the diagnosis can be confirmed.

3. Spinal cord hemorrhage: caused by spinal cord trauma or vascular malformation. Rapid onset, rapid back pain, paraplegia and sphincter dysfunction. The lumbar puncture of CSF is bloody, and the CT of the spinal cord can be seen as a high-density shadow of the bleeding site. Spinal cord vascular malformation can be found in the spinal cord DSA.

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