What is encephalomyelitis and how to treat it? Acute disseminated encephalomyelitis as a demyelinating disease of the central nervous system

The use of new diagnostic capabilities in medicine has influenced the identification immediate causes a number of diseases, and, accordingly, the treatment tactics and the natural outcome and consequences of the ongoing activities have changed. It was found that in the development of some demyelinating diseases nervous system infections (viruses, bacteria) and vaccines play a role. Demyelination is the destruction of the myelin sheath of the nerve. The most common demyelinating disease is acute disseminated encephalomyelitis (ADEM). If in the first case the etiological factor is not fully understood, then the causes of encephalomyelitis have been clarified and repeatedly confirmed by numerous studies.

Acute disseminated encephalomyelitis is a demyelinating disease of the central nervous system that occurs after past infection or vaccination, characterized by the development of cerebral and focal symptoms and more often a single-phase course.

One of the factors provoking the development of acute disseminated encephalomyelitis is vaccination

In the majority clinical cases An association between the development of ADEM and previous viral infection or vaccination has been described. It has been established that when an immune response against viruses is formed, the body synthesizes antibodies that begin to attack the myelin sheath of the nerve. The viruses themselves do not directly cause disseminated encephalomyelitis, but are trigger factors in the development of an autoimmune reaction.

Provoking factors include:

Viral infections (, rubella, chicken pox, flu, etc.).
Immunization (vaccines against hepatitis B, measles, rubella, polio, chickenpox, whooping cough, diphtheria, tetanus, etc.).
Bacterial infections (Borrelia, b-hemolytic streptococcus group A, Legionella). Recently, a number of authors have argued that bacteria can also act as a provoking factor.

In children, encephalomyelitis most often develops after measles, rubella, or chickenpox. In some cases, a previous infection cannot be identified.

There are 3 variants of the course of this disease:

Acute, monophasic (single-phase).
A lightning-fast course that ends in death.
Progressive course.

Symptoms

The disease begins with a prodromal period, which occurs 4-21 days after infection or vaccination. A person’s performance decreases, weakness and malaise appear. There are rises in body temperature, which the patient cannot associate with objective reasons. The period lasts several weeks, then is replaced by a period of appearance of neurological symptoms.

Clinical picture acute disseminated encephalomyelitis is polymorphic. The clinic distinguishes three main syndromes: intoxication, cerebral symptoms and focal symptoms.

Intoxication syndrome.

Patients are worried general weakness, loss of appetite up to its complete absence, rise in body temperature to febrile levels (39 0 C - 40 0 C), muscle pain (myalgia). Fever duration, as a rule, does not exceed 1-2 weeks. General infectious symptoms may be mild or absent.

General cerebral symptoms.

Drowsiness appears headache, vomit, . Some patients experience psychomotor agitation (they talk a lot, laugh, increased motor activity) or, on the contrary, deafness (inhibition in behavior, they speak reluctantly, answer questions little, take a long time). There are generalized seizures: the patient loses consciousness, falls, convulsions appear in the limbs and torso, and involuntary urination.

Focal symptoms.

Upon examination, it is detected 2-3 days after the onset of the disease. The clinical picture depends on which CNS structures are damaged by autoantibodies.

The following variants of ADEM are distinguished, depending on the predominant source of damage.

Disseminated encephalomyelitis.

The gray and white matter of the brain is damaged. There is a feeling of “crawling goosebumps” throughout the body, a feeling of tingling, numbness in the arms and legs. Weakness in the arms and legs (paresis). Pain in the limbs. Symptoms may appear on opposite parts of the body ( left hand And right leg, For example).

Opticomyelitis.

First of all, the optic nerves, spinal cord, and less often the brain are damaged. A person is worried about a decrease in visual acuity up to blindness, double vision (diplopia), loss of visual fields (scotomas). Visual impairment is combined with paresis (weakness) in the arms and legs, sensory disorders (numbness, crawling, pain, etc.), dysfunction of the pelvic organs (urinary incontinence, stool retention).

Polyencephalomyelitis.

Damage to the medulla oblongata and anterior horns of the spinal cord comes to the fore. Patients complain of impaired swallowing (dysphagia), impaired speech (dysarthria), impaired tone of voice (dysphonia), which is combined into. The muscles in the body atrophy, and weakness appears in the arms and/or legs.

Meningoencephalomyelopolyradiculoneuritis.

It occurs very rarely (more often in cases after vaccination against rabies or measles). The entire nervous system (brain, spinal cord, peripheral nerves and roots) is disseminated. A person complains about severe pain in the body, sensory disorders, muscle weakness.

Bickerstaff brainstem encephalitis.

Diagnosed in adolescence, often wears under acute course. Young people complain of gait disturbances (wobbly gait), weakness of facial muscles, speech disorders (“porridge in the mouth”), hearing loss and difficulty moving eyeballs. In this variant of the disease, these symptoms are associated with damage to the brain stem.

Acute cerebellar ataxia of Westphal-Leiden.

Children aged 2-5 years are affected. Occurs more often after chickenpox. The cerebellum is affected. Children have a gait disturbance (), chaotic movements in the arms and legs, accompanied by trembling and misses during purposeful actions (bringing a spoon to the mouth, writing letters, etc.). This option It is benign with complete recovery in most children within a few weeks.

Diagnostics

In the cerebrospinal fluid of persons suffering from this pathology, it will be found increased content leukocytes and protein

Clinical examination by a neurologist, infectious disease specialist.
Complete blood count (increased leukocytes, increased ESR).
(appearance of a large number of leukocytes in the cerebrospinal fluid, increased protein).
SCT or MRI of the brain and spinal cord.

Treatment

Corticosteroids are the drugs of choice in the treatment of disseminated encephalomyelitis (prednisolone, dexamethasone, methylprednisolone).
Plasmapheresis is used in severe cases.
Antiviral and antibacterial therapy prescribed when the causative agent of a previous infection is identified.
Symptomatic therapy (maintenance water-salt balance, cupping, etc.).

Consequences

The recovery period, as a rule, begins after a few days and can last from several months to several years (up to 2-3 years). Full recovery occurs in half of patients who have had encephalomyelitis. In some cases, the disease is fatal (10%). In 40% of people, a residual period or a period of residual persistent phenomena is formed, which is manifested by cognitive impairment (decreased memory, attention, absent-mindedness) and/or motor disorders(paresis of varying severity).

Disseminated encephalomyelitis is an acute inflammatory lesion central nervous system, which is presumably autoimmune in nature.

As a rule, this disease is a complication of a recent infectious disease or develops as a consequence of immunization. To cope with this disease, it is very important to consult a doctor in time. The specialist will make an accurate diagnosis and select adequate therapy.

The essence of the disease

Encephalomyelitis is considered a dangerous disease that combines damage to the spinal cord and brain. In severe cases, this disease even leads to death. In this case, it can also be observed full recovery. The prognosis depends on the activity of the abnormal process, the cause of the disease, and the adequacy of therapy.

Currently, it is customary to distinguish between two main forms of this pathology – primary and secondary encephalomyelitis. In the first case, the disease most often becomes a consequence viral infection. When secondary encephalomyelitis appears we're talking about about complications of common infectious pathologies. It can also develop after vaccination.

Types of violations and points of main impact

Depending on the area of damage, the following types of encephalomyelitis are distinguished:

However, disseminated encephalomyelitis is most often diagnosed. This form of the disease is characterized by the appearance of lesions that affect different parts of the brain and spinal cord.

Causes and risk factors

The causes of the development of disseminated encephalomyelitis are not fully understood. Scientists are still wondering why the immune system begins to synthesize proteins aimed at fighting nervous tissue.

However, the studies carried out allowed us to establish some regularities. Thus, the disease most often progresses after such events:

viral infections– especially those that provoke the appearance of specific rashes on the skin. Such diseases include herpes, chickenpox, rubella;
introduction of specific vaccines;
reducing the body's reactivity;
allergy;
colds.

Complex of symptoms

All manifestations of disseminated encephalomyelitis can be divided into 2 main categories - focal and cerebral. Thus, focal symptoms are represented by a significant variety of brain lesions. There are also certain combinations in the form of the following syndromes:

pyramidal;
cerebellar;
extrapyramidal;
oculomotor disorders.

All of these syndromes have a large number of manifestations, therefore only a qualified specialist can make an accurate diagnosis.

appearance;
disturbances of consciousness;
cognitive impairment– weakening of memory, decreased intellectual capabilities.

Also, against the background of this process, certain symptoms of dysfunction of the peripheral nervous system may appear. A fairly common condition in this case is.

Some people experience initial signs, which may include the presence of, which caused the appearance of disseminated encephalomyelitis, with an increase in temperature and.

Diagnosis and approach to therapy

Making an accurate diagnosis is not too difficult. Doctors usually perform it using contrast.

Clinical features of this disease can be easily seen on the screen or in pictures. If necessary, your doctor may prescribe a lumbar puncture.

Goals of therapy

With the development of disseminated encephalomyelitis, treatment should solve the following problems:

Treatment methods

Basic therapy of the disease is carried out with the help of anti-inflammatory steroid drugs. Depending on the complexity of the person’s condition, high or medium doses of Prednisolone are used. As the symptoms of the disease develop, the volume of the drug is gradually reduced. Corticosteroid therapy should be continued for 2-5 weeks.

It is important to take into account the negative aspects of such treatment, one of which is immunosuppression. To cope with this side effect, intravenous immunoglobulins are prescribed in parallel. In difficult cases, plasmapheresis is required. In this case, immune complexes and antibodies are removed from the body using a special device.

Etiological therapy for disseminated encephalomyelitis is carried out through antiviral drugs. Interferon analogues are usually used for this purpose.

IN in rare cases when the disease is of bacterial origin, they are used antibacterial drugs. The doctor may prescribe Ampiox, Gentamicin, Kefzol. If the pathology develops against the background of rheumatism, bicillin therapy is indicated.

A mandatory component is symptomatic therapy. According to indications, resuscitation measures can be carried out, artificial ventilation lungs, hemodynamic restoration. If the disease is accompanied by cerebral manifestations, you need to pay attention to prevention. For this, Diacarb, Magnesia, Furosemide can be administered.

For severe dysphagia, tube feeding is used. If a person has urinary retention, a catheter is inserted into the bladder.

In case of intestinal paresis, enemas should be done. is an indication for the prescription of anticonvulsant drugs.

To cope with neurological disorders that often accompany exacerbation of disseminated encephalomyelitis, you need to use B vitamins, ascorbic acid, and anticholinesterase drugs. These include Galantamine, Prozerin. For spasms muscle tissue the use of Mydocalm is indicated.

During convalescence, you need to use absorbable agents - Lidaza, Cerebrolysin.

Also during this period, nootropic drugs are indicated - Ginkgo biloba, Nootropil. In addition, doctors often prescribe neuroprotectors - in particular, Semax or.

To restore motor activity, you need to do massage and therapeutic exercises. Good effect gives transcranial magnetic stimulation.

During the period of exacerbation of encephalomyelitis, treatment is carried out in a hospital setting. During this period, potent drugs are used, and therefore traditional therapy is not used.

Folk remedies for restoring the body

During the recovery phase, effective recipes can be used to maintain the functioning of the nervous system:

Onions with honey. The onion needs to be peeled and chopped using a grater. Squeeze out the juice and mix in equal parts honey. Take a small spoon three times a day. This should be done before meals for a month.
Mumiyo. Literally 5 g of the product must be dissolved in 100 ml of water. Take a small spoon three times a day an hour before meals.
Ball-headed Echinops. To make the product, you need to take 3 large spoons of the fruits of this plant, pour 250 ml of boiling water and leave in a thermos for 12 hours. Drink small portions throughout the day. The course of treatment should be 2 months.

Complications and consequences

Some patients have persistent symptoms, which manifest themselves as visual impairment or sensory disturbances.

In some cases, disseminated encephalomyelitis is characterized by a severe course, the consequences of which result in, which can lead to death.

Forewarned and forearmed!

To prevent the development of the disease, you must adhere to the following rules:

avoid hypothermia and overheating during the vaccination period;
refrain from drinking alcohol during vaccinations;
Avoid physical overload during this period.

Disseminated encephalomyelitis is a very serious disease that can cause dangerous consequences. To avoid this, it is important to promptly consult a doctor who will select complex therapy.

Disseminated encephalomyelitis is a rare neurological disease that results from autoimmune disorders. Disseminated encephalomyelitis develops against the background of viral and infectious diseases occurring with high temperature. At timely application V medical institution The disease responds well to therapy, without developing complications in the future.

The Yusupov Hospital performs diagnostics of any complexity. If disseminated encephalomyelitis is suspected, the patient will be examined in as soon as possible. The sooner a diagnosis is made, the sooner effective treatment can be started. The Yusupov Hospital uses modern equipment.

Disseminated encephalomyelitis syndrome

The human immune system is aimed at protecting the body from harmful action foreign objects (viruses, bacteria, etc.). Elements of the immune system (lymphocytes, leukocytes, macrophages, antibodies) begin to fight pathogenic objects, trying to destroy them. In autoimmune conditions, elements of the immune system begin to attack, including healthy cells body.

Disseminated encephalomyelitis is an autoimmune disease in which pathological processes occur in the brain. The immune system destroys the myelin sheaths of neurons, thereby disrupting the functioning of brain cells.

The trigger for the development of disseminated encephalomyelitis is a viral or infectious disease with an increase in body temperature above 38C. Quite often, the cause of the development of disseminated encephalomyelitis is infection of the upper respiratory tract. Encephalomyelitis can also be caused by:

herpes virus,
Epstein-Barr virus,
cytomegalovirus,
chicken pox,
measles,
mumps,
rubella,
various bacteria.

Disseminated encephalomyelitis is more common in childhood, since the child’s immune system is still immature. Sometimes disseminated encephalomyelitis occurs after vaccination using a weakened live bacterium, which is also an abnormal response of the immune system.

Disseminated encephalomyelitis: symptoms

First signs neurological pathology appear one or several weeks after the first episode of fever. Disseminated encephalomyelitis begins as common cold with high fever, body aches. Then headaches arise, which are difficult to relieve with medications. After a short period of time, a more pronounced neurological picture develops:

confusion,
numbness in the arms and legs,
convulsions,
epileptic seizures,
speech disorders,
double vision,
swallowing disorder
drowsiness,
hallucinations,
breathing disorder,
coma.

Disseminated encephalomyelitis is characterized by a rapid increase in symptoms, so it is important not to delay a visit to the doctor. The Yusupov Hospital operates 24 hours a day, seven days a week, and will provide assistance at any time needed.

Disseminated encephalomyelitis with cerebellar ataxia

Disseminated encephalomyelitis affects various areas of the brain. The severity of the clinical picture will depend on the degree of damage to a particular area. Often disseminated encephalomyelitis affects the cerebellum, causing cerebellar ataxia. The pathology is manifested by impaired coordination of movements various groups muscles. Clumsiness in movements and incoordination are accompanied by intermittent speech and impaired coordination of eye movements. Gait is disturbed and may occur involuntary movements limbs.

Disseminated encephalomyelitis: diagnosis

The clinical picture of multiple encephalomyelitis is very similar to multiple sclerosis. After laboratory and instrumental methods diagnostics, the diagnosis of “disseminated encephalomyelitis” is established quite accurately. To determine the disease, the cerebrospinal fluid is examined using a lumbar puncture and an MRI is performed.

Cerebrospinal fluid analysis will show increased protein and lymphocyte levels. An MRI will clearly show areas of damage to the white matter of the brain. White matter is nerve fibers covered by the myelin sheath. In disseminated encephalomyelitis, the membrane is destroyed, forming lesions of various sizes. Visualization of the disease on MRI images helps to reliably establish the diagnosis.

Disseminated encephalomyelitis: treatment

Drug therapy is used to treat disseminated encephalomyelitis. The disease is highly treatable. Timely initiation of therapy is the key to rapid recovery and minimization of residual effects. The following drugs are used for treatment:

corticosteroids,
plasmapheresis,
antibiotics,
maintenance therapy drugs.

Corticosteroids significantly speed up the recovery process for disseminated encephalomyelitis. If they do not give the required result, plasmapheresis is immediately prescribed. Antibiotics are used if disseminated encephalomyelitis develops against the background bacterial infection. To normalize the patient’s condition, measures are taken to reduce the temperature, drugs that restore metabolic processes in the brain (nootropics) and general health-improving agents (vitamins, amino acids, etc.) are used.

At the Yusupov Hospital, patients receive a full range of medical services. The best neurologists in Russia work here, doctors of sciences with great experience treatment neurological diseases(including disseminated encephalomyelitis). The patient can receive treatment in a comfortable hospital, where he will receive round-the-clock qualified care. You can make an appointment and get advice from specialists by phone.

What is encephalomyelitis

Encephalomyelitis is an inflammatory process that simultaneously occurs in the brain and spinal cord. In fact, it is a combination of myelitis and encephalitis. As this disease progresses, a person experiences degeneration of myelin, which is a kind of insulating substance. nerve fibers. Thanks to it, the passage of electrical impulses becomes possible. Inflammatory processes also begin in the brain and blood vessels with the formation of necrotic areas.

Causes of pathology

The causes of encephalomyelitis have not yet been thoroughly studied. But during the research, it was noticed that most often the pathology progresses after:

viral infections, especially those that were accompanied by the appearance of skin specific rash (chickenpox, rubella, herpes);
colds;
allergic reaction;
introduction of specific vaccines;
traumatic brain injuries.

Scientists believe that encephalomyelitis may be hereditary in some patients. This is due to the fact that in such people some proteins of the nervous tissue have a similar structure to the proteins of infectious agents. As a result, the immune system mistakenly begins to attack its own myelin cells.

Despite the fact that encephalomyelitis can affect people of all ages, it is most often recorded in childhood. An interesting fact is that in children the disease is much milder than in adults.

Classification of the disease

Does not currently exist unified classification diseases. But experts distinguish several types of encephalomyelitis based on the nature of the inflammatory process, the rate of increase in symptoms, the localization of the lesion and many other factors. To determine what type of disease a patient has, doctors sometimes need to conduct several different examinations.

Based on the form and speed of development, the following types of encephalomyelitis are distinguished:

acute, in which symptoms increase over several hours;
subacute, developing over several weeks;
chronic, constantly progressing over a long time.

Based on the localization of inflammatory and necrotic foci, encephalomyelitis is divided into several types:

encephalomyelopolyradiculoneuritis, in which all parts of the central nervous system are affected;
polyencephalomyelitis - characterized by disorders in the nuclei of the cranial nerves and in the gray matter of the spinal cord;
optoencephalomyelitis - combines damage to the central nervous system and optic nerves;
disseminated (scattered) encephalomyelitis - is that small foci of inflammation are scattered in different parts of the central nervous system.

Encephalomyelitis is classified as:

primary - develops as an independent disease;
secondary - acts as a complication of another pathology.

Primary encephalomyelitis is usually caused by various neuroinfections. The cause may be viruses such as herpes, enterovirus, cytomegalovirus, etc. Most often, the course of such diseases is acute, the symptoms develop very quickly.

Some types of viral encephalomyelitis can be contagious, and loved ones need to take precautions when communicating with the patient.

Secondary encephalomyelitis develops against the background of other diseases or due to the influence of external factors:

infectious encephalomyelitis:
- viral - caused by influenza, herpes, rabies, etc. viruses;
- bacterial - the source is various pathogenic microorganisms(brucella, chlamydia, mycoplasma, toxoplasma, rickettsia);
post-vaccination - is a side effect of vaccinations, most often against diphtheria, whooping cough, measles, rubella and chickenpox;
myalgic is a fairly new disease, which is also called post-viral fatigue syndrome.

There are also special autoimmune types of encephalomyelitis, in which the body begins to confuse the myelin sheaths with foreign tissues of viruses and destroys them. These are the following varieties:

acute, subacute, chronic disseminated encephalomyelitis (differ in the speed of development of demyelination processes in the spinal cord and brain);
rabic post-vaccination - is secondary disease, observed 20 days after rabies vaccinations.

Symptoms of encephalomyelitis

Acute disseminated encephalomyelitis develops very quickly. In the early days, this disease may be confused with regular flu or ARVI, as a person’s temperature rises sharply, chills and muscle pain appear. But later other, more serious signs appear that indicate damage to the central nervous system. The first signs of this are cerebral and meningeal symptoms:

The patient's intracranial pressure increases, and blood microcirculation in the central nervous system is disrupted. Severe headaches and dizziness are felt almost immediately. The person becomes lethargic, sleepy, and may lose appetite. If you change positions, walk or look at the light, or hear loud sounds, the pain in your head will intensify.
It is very common to experience persistent nausea. Even after vomiting there is no relief, the patient continues to feel sick.
At some point, convulsions may occur, and muscles in different parts of the body begin to contract involuntarily. Most often, this symptom appears in young children and adolescents.
The mental state can be either depressed or overexcited. IN the latter case patients may behave aggressively, become very nervous, and perform chaotic and unnecessary actions.
IN severe cases consciousness is depressed. Patients begin to delirium, see hallucinations, fall into a lethargic state, become as if stunned, and have difficulty perceiving what is happening around them. If the condition worsens, coma may occur.
One of the common meningeal symptoms is stiffness (increased stiffness) of the neck muscles. They become uncontrollable, and the patient cannot bend his head down and reach lower jaw to the chest.
Brain damage is checked by the Brudzinski test. If a patient lying on his back tilts his chin toward his chest, his legs will involuntarily bend at the knees.

Also, with acute disseminated encephalomyelitis, various focal symptoms appear, which indicate specific affected structures of the central nervous system:

Pyramid signs appear very strongly in those patients whose neurons in the cerebral cortex are damaged. Due to them, conscious muscle contractions should normally be produced. But during the disease, people experience paralysis of the lower and upper limbs, the ability to squeeze the hand and make small movements decreases. Patients also experience increased tendon reflexes, and when struck with a special hammer on the knee or elbow, the limbs begin to twitch too sharply. In some cases, facial expressions may be impaired and paralysis of the oculomotor nerve may occur.
Cranial nerve damage is usually associated with optic nerve degeneration. Almost 30% of all patients with encephalomyelitis have vision problems. In mild cases, the severity may decrease slightly, and with more serious lesions the person even goes blind. If other nerves are affected, problems may begin with swallowing reflex, hearing loss appears, the sense of smell disappears.
Aphasia (partial or complete loss of speech) occurs when the speech centers of the brain are damaged.
Isolated transverse spinal cord lesions are observed in a quarter of all patients with encephalomyelitis. External manifestations sometimes it is not observed and abnormalities are detected by magnetic resonance imaging. However, urinary and fecal incontinence, paralysis of the arms and legs, and decreased sensitivity in different parts of the body may occur.
Damage to the cerebellum manifests itself as a very characteristic lack of coordination. A person may have difficulty walking; it becomes unsteady and unsteady. Fine motor skills are also impaired. During the examination, the patient cannot eyes closed get your finger into the tip of your nose.
Polyneuropathy of the extremities manifests itself in a slight decrease in the sensitivity of the arms and legs, and the skin may tingle slightly. Muscle strength also decreases and limbs become weaker.

If treatment is not started on time acute encephalomyelitis, then it can develop into a chronic form, which is much more difficult to get rid of. It is characterized by alternating exacerbations and remissions. But periods of calm can be very short-term, and soon a deterioration in well-being occurs again. At this time, the symptoms completely repeat the course of acute disseminated encephalomyelitis. It is worth understanding that the patient’s condition will only get worse and worse.

Opticoencephalomyelitis, in addition to the main symptoms, is characterized by various lesions of the optic nerve. Patients begin to complain of decreased visual acuity, sometimes a veil appears before the eyes, which prevents them from clearly seeing the surrounding space. Also a common symptom is the appearance of pain in the orbit, which tends to progress as the disease progresses.

Very interesting and recent open view encephalitis is its myalgic form, which doctors otherwise call post-viral fatigue syndrome. Occurs after various viral diseases or vaccinations. Doctors are not always able to establish the correct diagnosis, since the symptoms are very similar to a common infectious disease:

constant feeling of fatigue;
energy depletion even after a small load;
aching joints;
muscle pain;
depressive states;
frequent mood changes;
indigestion.

Video: chronic fatigue syndrome after infectious diseases

Diagnostics

At the first signs of encephalomyelitis, you should consult a neurologist. He will be able to make a primary diagnosis after examining the patient and taking an anamnesis. If a person has provoking factors, such as infectious lesions or a recent vaccination, then this is with high probability indicates encephalomyelitis. Additionally, the doctor prescribes the following studies:

magnetic resonance imaging (MRI) - allows you to obtain very accurate layer-by-layer images of any part of the body and see tumors, areas of inflammation or necrotization, hemorrhages and other disorders in the central nervous system;
computed tomography (CT) - helps to examine internal organs, including the brain and spinal cord, using x-rays;
myelography is an x-ray method for examining the spine using special contrast agents that allow you to see various diseases spinal cord.

The following tests may also be prescribed:

lumbar puncture with collection of cerebrospinal fluid, in which an increased content of proteins and lymphocytes will be visible;
blood test for antibody levels, in which IgA and IgE will be elevated.

Differentiation of pathology

During differential diagnosis, it is very important to distinguish encephalomyelitis from multiple sclerosis. The latter disease is chronic and constantly progressive, as a result the myelin sheath of the nerves is also destroyed. It usually begins with focal symptoms, while encephalomyelitis first manifests itself with general cerebral and intoxication signs.

Also differential diagnosis carried out with encephalitis, meningitis, tumor formations in the brain, etc.

Treatment

Encephalomyelitis can only be treated under the supervision of a doctor. This is very serious illness and self-prescribe medications or folk remedies may be life-threatening. Each patient is treated individual approach and medications are prescribed based on the cause of encephalomyelitis. If a person is in a very in serious condition, then the following procedures will be required:

artificial ventilation of the lungs in case of respiratory dysfunction;
plasmaphoresis to cleanse the blood of antibodies and various immune complexes;
tube feeding for impaired swallowing reflex;
installation of a catheter in bladder in cases of urinary retention;
cleansing enemas for paresis of the intestinal tract.

Drug therapy

At drug treatment The dosage and regimen of medications is selected individually by the attending physician. There is a whole range of drugs that are prescribed for different types encephalomyelitis:

Antiviral drugs - prescribed for an infectious cause of the onset of the disease (leukocyte human interferon).
Antibiotics - needed in case of bacterial infection (Ampiox, Kefzol, Gentamicin). At chronic tonsillitis Bicillin is prescribed.
Margulis-Shubladze vaccine - prescribed for infection with rabies or human acute encephalomyelitis virus. It is carried out in the subacute period for those patients who exhibit small residual effects after the disease.
Steroidal anti-inflammatory drugs - necessary due to the autoimmune nature of encephalomyelitis (Prednisolone).
B vitamins are prescribed to support the functioning of the nervous system (Neuromultivit).
Vitamin C is effective for maintaining and strengthening the immune system and increasing the body's resistance to infections.
Diuretics are necessary in the presence of cerebral edema (Furosemide, Diacarb).
Antispasmodics - indicated for various tremors and convulsions (Dibazol).
Muscle relaxants are prescribed to those patients who have increased muscle tone (Mydocalm, Cyclodol).
Nootropic drugs are necessary to restore higher mental functions of the brain (Encephabol, Piracetam).

Photo gallery: drugs used in the treatment of encephalomyelitis

Folk remedies

Encephalomyelitis is a very serious disease that cannot be treated with traditional medicine. During periods of exacerbation, treatment is carried out only in a hospital with potent medications that are aimed at achieving a quick effect.

During the period of remission or rehabilitation, it is permissible to use traditional medicine, but only after consultation with the doctor.

Potato compress with honey

In some situations it is possible to use warm compresses on the affected areas of the spine, if the disease is not in the acute stage. They are not allowed to be placed in the heart and neck area.

You can use a compress of potatoes with honey:

Take a few potatoes, boil them, mash them, mix with two tablespoons of honey and place in cheesecloth.
Place the wrapped cake on the skin previously lubricated with nourishing cream. Cover the patient with a blanket or blanket and leave for one hour.
After the designated time, remove the compress and wipe the skin dry. It is best to carry out this procedure at night, so that after it the person falls asleep and does not get out of bed until the morning.

Infusion of Mordovnik sharogolatum

The use of Echinops infusion is effective for various lesions central nervous system, it promotes recovery motor activity limbs. Skeletal muscles are also toned.

To prepare the medicine you need:

Take three tablespoons of fruit and pour a glass of boiling water.
Leave for ten hours in a thermos.

Take 2 teaspoons of infusion twice a day before meals. The course of treatment is about two months.

Onion juice with honey

This remedy is excellent for restoring the body's strength after encephalomyelitis. Phytoncides contained in onions have antibacterial effect. Honey helps eliminate inflammatory processes, improves metabolism.

Onion juice can be made in any convenient way. You can use a juicer, grater or other device. The resulting liquid must be mixed with the same amount of honey. For one month, you need to take one teaspoon of the resulting product three times a day before meals.

Rehabilitation

Patients do not always fully recover from encephalomyelitis. Many people require various rehabilitation procedures to improve the functioning of all parts of the body. Before complete cure You should avoid going to saunas, steam baths and sunbathing.

Restorative massage

Only a specially trained person should perform therapeutic massage on patients who have suffered encephalomyelitis. During the procedure, the skin, subcutaneous tissue, blood vessels and nerve endings. Thanks to improved blood circulation, metabolism is restored, the affected limbs begin to return to health faster. normal condition, strength increases in muscles weakened by the disease. Massage will also be useful for those patients who have increased muscle tone and experience spasms. The attending physician must refer you for the procedure, as there may be contraindications.

Physiotherapy

After encephalomyelitis, there are often cases when patients feel weakness in the limbs and disturbances in gait and motor skills appear. In this situation, physical therapy exercises show good results. An individual complex is selected for each person, which helps to maximize the use of the affected areas, strengthen the muscle corset and improve blood circulation.

If the patient is in a supine position, he can perform gymnastics directly on the bed. Here are some exercises:

Bend your elbows and rest them on the surface of the bed. Rotate the brushes first clockwise, then in the other direction. Then clench your fists and unclench them completely, spreading your fingers in different directions.
Stretch your calves while lying down. Point your feet toward you, and then point your toes out. Then perform rotational movements with your foot.

If the patient is able to walk, then it is necessary to perform exercises that consist of bending the torso forward and backward, from side to side and clockwise. You should also try to touch the floor with your fingers. Don’t forget about the cervical spine; it needs to be warmed up by performing head rotations.

Video: exercise therapy complex for the lower extremities

Transcranial magnetic stimulation

This procedure is necessary for those people who, after encephalomyelitis, have various paresis and paralysis of the limbs. Using a special device, the motor cortex of the brain is stimulated, and the specialist observes which muscles begin to contract in the patient. Based on the results obtained, it is possible to trace the dynamics of conductivity improvement nerve impulses and identify remaining areas of affected motor pathways.

Electrical myostimulation

It is better to carry out this procedure in a clinic with a doctor. With the help of weak electrical impulses, the patient’s muscles are affected, due to which they begin to contract. There is a kind of imitation of a natural process in the body. Thanks to this method, muscle tissue is restored, metabolism is normalized, and the functioning of the nervous system is improved.

Thermal treatments

If the patient experiences paralysis due to increased muscle tone or spasms, the doctor may prescribe warm baths:

Turpentine baths due to essential oils and terpenes have irritant effect on the nervous system and promote the production of heparin, prostaglandins and various mediators. Blood circulation and metabolism improve, and the process of restoration of damaged tissue occurs. For a bath with a volume of two hundred liters, you need to add approximately 50 ml of turpentine solution. The water temperature should be 37 o C. Take baths every other day for ten minutes. The course consists of 10 procedures.
Mustard baths also have an irritating effect on the skin and nerve endings. Patients' immunity is increased and blood circulation is activated. Add 150 g of mustard to the bath; the water temperature should not be higher than body temperature. The duration of the procedure is five minutes. 10 sessions are carried out every other day.
Sage baths, due to evaporation and the influence of essential oils, help accelerate metabolic processes and improve the functioning of the cerebral cortex. Add 50 ml of musk sage concentrate to the bath. The water temperature should be 36–37 o C. Carry out the procedure every other day for fifteen minutes. For myelitis, 10 sessions are indicated.

Video: turpentine baths

Prognosis and possible complications

In almost 70% of cases, encephalomyelitis is completely cured and leaves no consequences. But in some situations, the following residual effects and complications may be observed:

urinary and fecal incontinence;
partial paresis of the limbs;
weakness in arms and legs;
formation of bedsores;
visual and hearing impairment;
impaired coordination of movements;
aphasia;
paralysis;
various mental disorders.

The duration of treatment depends on the timeliness of contacting a doctor and the speed of development of symptoms. The more pronounced pathological signs, the more difficult it is for the patient to recover. In most cases, a person’s life span is not shortened and after recovery he can return to his normal rhythm of life. Lethal outcomes, depending on the type of encephalomyelitis, range from 5 to 20%.

Currently, there have been cases of transition from multiple encephalomyelitis to multiple sclerosis. Scientists cannot yet accurately identify the reasons for this process. This usually occurs in those patients in whom the acute course of the disease has become chronic.

If a woman was pregnant and fell ill with infectious encephalomyelitis, this may affect the condition of the fetus. The ability to give birth is determined individually, depending on the patient’s condition. It also takes into account what medications were taken, since many of them have Negative influence on the development of the child. Sometimes an abortion may be indicated.

Acute disseminated encephalomyelitis (ADEM) is a pathology of the nervous system that occurs as a result of autoimmune disorders. Acute disseminated encephalomyelitis is also called acute disseminated disseminated encephalomyelitis because the disease is associated with the process of demyelination. In ADEM, damage occurs to the myelin sheath that surrounds nerve fibers. As a result, the functioning of the brain and spinal cord is disrupted.

Neurologists at the Yusupov Hospital accept patients of any severity and, thanks to experience and the use of advanced treatment methods, help get rid of the disease and return to a full life. For each patient, treatment is selected individually, depending on the clinical picture of the disease and individual characteristics body.

Acute disseminated encephalomyelitis: consequences

OREM is rare disease. Most often it is recorded in childhood, which is associated with the characteristics of the immune system. The disease responds well to treatment if therapy is started in a timely manner. Acute disseminated encephalomyelitis can be cured with medication and in most cases the disease leaves no consequences.

Sometimes residual lesions of the brain persist for life, which threatens relapse of the disease or the development of multiple sclerosis in the future. After acute disseminated encephalomyelitis, decreased vision and sensory disturbances may occur. In severely advanced cases of the disease, significant disturbances of consciousness occur. In rare cases it occurs death due to cerebral edema.

Acute disseminated encephalomyelitis: causes

The development of acute disseminated encephalomyelitis is based on autoimmune reactions to myelin antigens. Today, medicine is still studying the mechanisms of development autoimmune diseases. In the case of ADEM, components of the immune system begin to perceive myelin as a foreign element and attack it. It is impossible to say with certainty why the immune system begins to behave this way. The trigger for the development of ADEM is usually a viral or bacterial disease, at which there is an increase in body temperature above 38C. Most often, ADEM is observed during an infectious disease of the upper respiratory tract. Also, the development of WECM can be provoked by:

herpes virus,
cytomegalovirus,
Epstein-Barr virus,
measles,
chicken pox,
mumps,
rubella,
various bacteria.

Some cases of acute disseminated encephalomyelitis are associated with a reaction to vaccination. When a vaccine containing a live, attenuated bacterium or virus is administered, an inappropriate immune system response may occur, leading to the development of ADEM.

Acute disseminated encephalomyelitis: symptoms

The onset of the disease is acute, it is similar to the appearance respiratory infection: body temperature rises (sometimes significantly), chills and weakness occur. There are severe headaches, numbness in the arms and legs. Signs neurological disorders occur several days after the first episode of fever:

confusion,
lack of coordination
convulsions,
epileptic seizures,
speech disorders,
swallowing disorder
drowsiness,
hallucinations,
breathing disorder.

In case of defeat optic nerve arise visual disturbances: double vision, white spots before the eyes, difficulty focusing. Impaired consciousness can lead to coma.

ADEM symptoms increase quickly, so it is important not to put off visiting a doctor until later. At the first signs of damage to the nervous system, you should seek medical attention. medical care. The Yusupov Hospital accepts patients at any time of the day or night, any day of the week. The hospital employs experienced neurologists who successfully treat neurological diseases. The clinic uses the latest equipment, which allows diagnosis of any complexity and in the shortest possible time, which is important in the treatment of acute disseminated encephalomyelitis, because the sooner therapy begins, the greater the chance of a successful recovery without residual effects.

Diagnosis of the disease is performed using cerebrospinal fluid analysis and MRI. MRI images will clearly show characteristic lesions in the white matter of the brain.

Acute disseminated encephalomyelitis: treatment

For ADEM treatment use complex drug therapy. Corticosteroids are used intravenously for 3-5 days to suppress the abnormal immune response. If the use of drugs does not produce results, plasmapheresis is prescribed in a course of 4-5 sessions.

If there is a bacterial infection that provokes disseminated encephalomyelitis, the patient is prescribed antibiotics. When installed viral nature a-interferon or interferonogen preparations are used to provoke a provoking factor.

During treatment, measures are taken to reduce body temperature. Restoration of metabolic processes in the brain is carried out with the help of nootropic drugs. Medicines are used to normalize the functioning of the circulatory system and reduce intracranial pressure. Additionally, general maintenance therapy drugs (amino acids, vitamins, etc.) are used.

Treatment of acute disseminated encephalomyelitis at the Yusupov Hospital is carried out with all the necessary drugs that have proven their effectiveness, which allows achieving the most positive results in treating the disease.

To restore cognitive and social functions, the patient is prescribed a course of rehabilitation. The rehabilitation clinic of the Yusupov Hospital employs the best rehabilitation specialists who use modern and effective techniques physical therapy, massages, physiotherapy. If necessary, the patient can consult a psychiatrist.

The Yusupov Hospital has created the most comfortable conditions for the recovery of patients. You can make an appointment and get advice from specialists by phone.

Bibliography

ICD-10 (International Classification of Diseases)
Yusupov Hospital
"Diagnostics". - Brief Medical Encyclopedia. - M.: Soviet Encyclopedia, 1989.
“Clinical assessment of laboratory test results”//G. I. Nazarenko, A. A. Kishkun. Moscow, 2005
Clinical laboratory analytics. Fundamentals of clinical laboratory analysis V.V. Menshikov, 2002.

Prices for the diagnosis of disseminated encephalomyelitis

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Toxic-allergic or viral etiology. Multiple foci of necrosis, myelin disintegration, and a vascular-inflammatory reaction appear in the brain and spinal cord. Encephalomyelitis can develop in children and adults due to infection, intoxication, or be independent disease(primary acute disseminated encephalomyelitis).

Encephalomyelitis is divided into primary, which occurs as a result of damage by neurotropic viruses to the brain and spinal cord, and secondary, which develops against the background of a previous infection or after a certain period after vaccination.

In the development of encephalomyelitis, an important role is given to allergic reactions organism, arising in response to the introduction of a virus or autosensitization.

Acute disseminated encephalomyelitis is a viral disease with a sudden onset, high fever, headache, dizziness, vomiting, decreased vision, and pain in the extremities. Patients are diagnosed with paresis and paralysis of the limbs with increased muscle and reflexes, coordination disorders with staggering when walking, the inability to make fine movements (writing, eating, holding dishes, fastening clothes, combing their hair, washing), which appears in the limbs. Scanning, slurring, choking when eating, and urination problems are often observed. After 2-3 months. There is a partial regression of symptoms, but often motor and coordination disorders remain. The disease is difficult to distinguish from (see). The latter is characterized by a wave-like course, the replacement of some foci of damage to the nervous tissue by others, a gradual worsening of the defect with each exacerbation of the disease. encephalomyelitis is usually unfavorable; in most cases there are persistent residual effects (paralysis, paresis).

Rabies post-vaccination encephalomyelitis develops rarely and is classified as secondary encephalomyelitis. On the 10-20th day after the start of vaccinations against rabies, symptoms of damage to the brain and spinal cord are detected, sometimes in combination with damage to peripheral nerves and roots. Headache, lower back pain occurs, and temperature rises. Over the course of several days, paresis and paralysis of the limbs develop, tendon reflexes increase, and pathological reflexes, the act of urination becomes difficult, up to complete urinary retention. Patients complain of pain in the muscles, painful nerve trunks, and when the roots are pulled, the pain increases sharply. Leukocytosis is observed in the blood, possibly in the urine, with a moderate increase in protein and cells. Prognosis: occurs in mild cases full recovery lost functions; in more severe cases, permanent consequences are observed.

Treatment. If encephalomyelitis is suspected, the patient should be referred to a neurologist. Treatment should be carried out in a hospital setting. In all cases of encephalomyelitis (primary and secondary), vitamins are recommended: 5% solution 1 ml intramuscularly, 2.5% solution 1 ml intramuscularly, cyanocobalamin () 200 mcg intramuscularly, ascorbic acid (C) orally 0.2 g from 0.02 g 3 times a day. Prescribe 20-30 mg per day for 10-20 days (the drug should be discontinued with caution, gradually reducing the dose), as well as antihistamines - diphenhydramine, pipolfen, suprastin (in usual dosages) and dehydration drugs - magnesium sulfate 25% solution 10 ml intramuscularly, Lasix orally 25 mg 3 times a day. Whenever respiratory disorders patients are provided with special assistance medical hospitals. Cardiac medications and painkillers are used.

To prevent rabies encephalomyelitis, it is necessary to avoid cooling or overheating during vaccinations, alcohol consumption is prohibited, and vaccinated persons must be freed from severe physical work and night shifts. According to indications, hyperimmune gamma globulin is used.

Encephalomyelitis (from the Greek enkephalos - brain and myelos - spinal cord) is inflammation of the brain and spinal cord, a syndrome of multifocal damage to the central nervous system in many infectious and infectious-allergic diseases.

Acute encephalomyelitis occurs as one of the clinical options at primary encephalitis, as well as with general infectious diseases, especially during acute childhood infections (measles, rubella, chicken pox, etc.) or after them. Based on the common pathogenesis and pathomorphological changes, these forms of diseases are combined into the group of so-called parainfectious encephalomyelitis. Pathogenetically close to them are encephalomyelitis, which occurs after vaccination against smallpox, vaccination against rabies, tick-borne encephalitis, typhoid-paratyphoid diseases, intestinal infections, as well as after the administration of blood serum preparations.

Encephalomyelitis with predominant damage to the gray matter (poliomyelitis, tick-borne and epidemic encephalitis, Born's disease, etc.) is called polioencephalomyelitis. In parainfectious, post-vaccination and acute disseminated encephalomyelitis, the white matter of the brain and spinal cord (leukoencephalitis) is more affected, sometimes in combination with damage to the spinal roots (encephalomyelopolyradiculoneuritis) and cranial, in particular optic (opticoencephalitis, neuromyelitis optica), nerves. In the acute phase, the membranes of the brain are often involved in the process (meningoencephalomyelitis). Chronic encephalomyelitis syndromes are not nosologically separated from the underlying disease, for example, cerebrospinal syphilis or some forms of multiple sclerosis.

In addition to the mentioned secondary encephalomyelitis, primary acute disseminated encephalomyelitis is also distinguished. Acute disseminated encephalomyelitis is considered as a clinical form in the group of demyelinating lesions of the nervous system. The disease occurs everywhere, the largest number of cases are described in European countries; Both children and old people are affected, but young people predominate.

Etiology. Various theories of the etiology of encephalomyelitis have been put forward: toxic, vascular (thrombosis of the central nervous system vessels), lipolytic, infectious, allergic. For acute disseminated encephalomyelitis, the most reasonable assumptions are about its infectious or neuroallergic nature. Soviet researchers (M. S. Margulis, V. D. Solovyov, A. K. Shubladze and S. Ya. Gaidamovich) managed to isolate from blood, cerebrospinal fluid and the brains of deceased patients with acute disseminated encephalomyelitis are identical strains of the virus, which in its antigenic and biological properties is close to the rabies virus and different from the viral pathogens of other diseases (see Multiple sclerosis).

Experience in the clinical study of acute disseminated encephalomyelitis using specific (serological) methods gives reason to believe that this includes diseases of various etiologies. Only in some patients the diagnosis is confirmed by the detection in the blood of specific antibodies to the acute disseminated encephalomyelitis virus (A. G. Panov, A. P. Zinchenko). The similarity of the clinical picture and pathomorphology of acute disseminated encephalomyelitis with vaccine encephalomyelitis gave rise to the allergic theory of pathogenesis and etiology of the former. This theory gained widespread acceptance after experimental encephalomyelitis was obtained in animals after repeated parenteral administration of emulsions and extracts of normal brain tissue. From the standpoint of the allergic theory, demyelinating encephalomyelitis is a group of diseases united by a common pathogenesis (neuroallergy) with a variety of etiological (sensitizing) factors.

Pathological anatomy . The main features of encephalomyelitis include a vascular inflammatory process predominantly in the white matter of the brain and spinal cord. The changes concern mainly venous and precapillary vessels. Multiple foci of demyelination with disintegration of myelin sheaths and only partial defeat axial cylinders.

In both white and gray matter, glial nodules of proliferating meso- and microglial elements are found. Neuronophagia is rare. M. S. Margulis emphasizes the frequency of disseminated miliary and larger foci of necrosis, not associated with vascular changes. He classifies them as the earliest and main features of the pathomorphology of acute disseminated encephalomyelitis, characteristic of infectious viral damage to the nervous system.

Distinct inflammatory changes with secondary degeneration of fibers were often detected in roots, nerve trunks, epidural tissue and membranes.

Clinical picture diseases are varied. There are various combinations of symptoms of damage to the hemispheres and brainstem, cerebellum, spinal cord, often in combination with damage to the cranial nerves and roots. For the diagnosis of encephalomyelitis, the multifocality of the process and predominant defeat white matter of the brain.

The disease often develops acutely, against the background of a moderate (up to 37.5-38.5°) increase in body temperature. The initial manifestations are multi-symptomatic, with various paresthesias in the limbs and trunk, decreased vision, and diplopia. Soon, these symptoms may be accompanied by hemi- and paraparesis of the central type, disturbances of statics and coordination. Spinal symptoms are usually multifocal and diffuse. Sometimes, at the onset of the disease, more or less pronounced cerebral and meningeal symptoms are observed: headache, nausea and vomiting, stupor or confusion. However, disturbances of consciousness and other cerebral symptoms, as well as meningeal syndrome, are expressed moderately.

Changes in the cerebrospinal fluid are inconsistent and uncharacteristic. Protein cell dissociation with a moderate (up to 1‰) increase in protein content with normal cytosis is more common, and moderate pleocytosis is less common.

In some cases, symptoms of damage to the roots occupy a significant place in the picture of the disease: pain, paresis and sensitivity disorders in the feet and hands, muscle atrophy. In such patients, a combination of symptoms of damage to the central and peripheral nervous system is striking. In addition to the optic nerves (retrobulbar neuritis), the oculomotor, abducens, facial nerves. Rarely, symptoms of bulbar palsy develop.

General infectious symptoms are usually moderate. Body temperature drops to normal after 3-7 days; sometimes the disease develops with normal or low-grade fever. Blood changes are irregular and insignificant; Some patients have leukocytosis (up to 10,000 in 1 mm 3) and a slightly accelerated ROE.

The course of the disease is characterized by a short phase of increasing symptoms and often significant reversibility even with severe paresis. Most patients end up with moderate pyramidal and cerebellar disorders. Radiculoneuritic symptoms usually disappear completely. With optic neuritis, vision remains reduced, persistent scotomas or blindness are detected. With cerebral paresis, recovery is more complete than with spinal paresis. Occasionally, epileptic seizures occur later. Along with this, some patients experienced almost complete restoration of functions, despite severe impairments in the acute phase of the disease. There are indications of the possibility of a recurrent course of acute disseminated encephalomyelitis. There are known observations indicating the possibility of transition of acute disseminated encephalomyelitis into chronic stage with a picture of multiple sclerosis; on the other hand, with multiple sclerosis exacerbations are possible, occurring with clinical manifestations such as acute disseminated encephalomyelitis.

Circle clinical manifestations Acute disseminated encephalomyelitis cannot be accurately defined due to the lack of generally accepted criteria for its diagnosis. D. S. Futer identifies: 1) the main type with damage to all parts of the nervous system (encephalopolyradiculoneuritis); 2) optoencephalomyelitis - a combination of optic neuritis with cerebral or spinal paresis (opticomyelitis, optoencephalomyelitis); 3) disseminated myelitis with transverse or partial damage to the spinal cord, sometimes with Brown-Séquard syndrome; 4) polioencephalomyelitis with symptoms of damage to the nuclei of the brainstem and gray matter of the spinal cord. Other syndrome classifications differ in detail.

Apparently, in some patients, acutely developed retrobulbar optic neuritis can be attributed to initial manifestations or monosymptomatic forms of acute disseminated encephalomyelitis.

Mortality in acute disseminated encephalomyelitis varies; according to the total data, it does not exceed 8%.

Diagnosis is based on taking into account such features of the clinic and the course of the disease as an acute onset against the background of moderately expressed general infectious cerebral and meningeal symptoms, rapid progression of the disease according to the appearance of new lesions in various parts of the central and peripheral nervous system, multifocality of the lesion and the predominance of conduction disorders, frequent defeat optic nerves. The diagnosis of acute disseminated encephalomyelitis at the present stage of knowledge characterizes only a clinical syndrome that does not predetermine the etiology of the process. Therefore, in all cases, one should try to find out possible etiological factors (relationship with other diseases, preventive vaccinations, injections of serum drugs, etc.).

In some cases, if there is a suspected connection between acute disseminated encephalomyelitis and a certain viral disease(choriomeningitis, tick-borne encephalitis, etc.) can be used specific methods diagnostics It is advisable to study the blood of patients in reactions of neutralization and complement fixation with the acute disseminated encephalomyelitis virus. An allergic skin reaction to intradermal administration of 0.5 ml of the Margulis-Shubladze vaccine can also be used for diagnostic purposes. This will allow from a polymorphic group of diseases united clinical form acute disseminated encephalomyelitis, to identify an etiologically homogeneous variant of the disease caused by the encephalomyelitis virus.

Treatment. When diagnostic tests confirm the etiological role of the acute disseminated encephalomyelitis virus, it is advisable to use the Margulis-Shubladze vaccine according to the generally accepted scheme. In other patients, in addition to symptomatic remedies, desensitizing and hormonal drugs(diphenhydramine - 0.05 g 2 times a day for a month, pipolfen 0.025 g 2 times a day, prednisolone - 5 mg according to the schedule, dexamethasone, etc.) in combination with antibiotics and vitamins B1 - 5% solution 1 ml (intramuscular 25 injections) and C. After the acute period, generally accepted methods of rehabilitation therapy are used: vitamins B12 - 200-500 mcg daily, 20 injections, B1, amino acids, biogenic stimulants, anticholinesterase (proserin injection 0.05% - 1 ml subcutaneously) and stimulant drugs, physiotherapy, massage, physiobalneotherapy.