How to check for demyelination in the brain

Demyelination of the brain is a relatively common disease, which poses a great threat to human health. We know that the function of the myelin sheath is to protect neurons. If this disease occurs, the transmission of neurons will be significantly affected, and it will often cause the occurrence of multiple diseases. Therefore, it is necessary to conduct a joint examination in a timely manner, including inquiries about medical history, including some symptoms, and physical examinations, including some auxiliary examinations, etc.

How to check for demyelination in the brain

1. Medical history and symptoms:

Most cases occur in young and middle-aged people who have symptoms of upper respiratory infection or a history of vaccination within two weeks before the onset of the disease. There are triggering factors such as cold, overwork, and trauma. The initial symptoms are numbness and weakness of both lower limbs, back pain and tightness in the corresponding part of the lesion, urinary retention and fecal incontinence.

2. Physical examination findings:

1. In the early stage, the disease manifests as flaccid paralysis due to the "spinal shock period". After the shock period (3-4 weeks), the limbs controlled below the lesion site show upper motor neuron paralysis. 2. The deep and shallow sensations below the lesion plane disappear, and some parts may have a hypersensitive zone at the lesion plane. 3. Autonomic nervous system disorders: manifested as urinary retention, large amounts of residual urine, filling incontinence, and fecal incontinence. After the shock period, reflex bladder, constipation, and abnormal penile erection appear.

3. Auxiliary examination:

1. In the acute phase, the peripheral blood leukocyte count is normal or slightly high. 2. Cerebrospinal fluid pressure is normal, white blood cells and protein are slightly increased in some patients, and sugar and chloride levels are normal. 3. Spinal cord MRI showed thickening of the spinal cord and abnormal signals at the lesion site.

4. Identification:

It needs to be differentiated from acute epidural abscess, spinal tuberculosis, spinal metastatic tumors, neuromyelitis optica, and spinal cord hemorrhage.

1. Demyelinating disease occurs when the myelin sheath of the axons of the brain and spinal cord is lost. There are two types of causes: myelin destruction; myelin formation disorders. Inflammatory demyelinating disease of the spinal cord is an immune-mediated disease with the following clinical characteristics: ① All patients are children and young adults; ② Acute onset, often with a history of cold, fever, infection, rash, vaccination, cold, childbirth or surgery one month before the onset of the disease; ③ Comprehensive neurological examination can often find evidence of other central nervous system involvement in addition to spinal cord symptoms and signs; ④ Cerebrospinal fluid examination shows positive oligoclonal bands; ⑤ Electrophysiology and MRI can detect some subclinical lesions in the brain; MRI detects abnormal signals in the white matter of the brain. Some inflammatory demyelinating lesions of the spinal cord present as "pseudotumor-like" lesions, with mild space-occupying effect and mild surrounding edema on MRI, and may have flake-like hemorrhage signals, which can easily be misdiagnosed as spinal cord tumors. Medical treatment is ineffective. 2. Symptoms and signs: Demyelinating myelitis is mostly acute multiple sclerosis (MS) spinal cord type. The clinical manifestations are similar to post-infectious myelitis, but the progression is slower, and the disease often reaches its peak within 1-3 weeks. The prodromal infection may not be obvious, and is mostly an incomplete transverse lesion, manifested by weakness or paralysis of one or both lower limbs, accompanied by numbness, the level of sensory impairment is not obvious or there are two planes, and urinary and bowel disorders occur. Evoked potentials and MRI examinations may reveal lesions in other parts of the CNS.