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International Medical Scientific Journal        Issue-3 

10.5281/zenodo.5639620 

38 

    



Art of Medicine           Volume-1 

International Medical Scientific Journal        Issue-3 

10.5281/zenodo.5639620 

39 

 

Art of Medicine International Medical Scientific journal 

 

Founder and Publisher Pascual Izquierdo-Egea 

Published science may 2021 year. Issued Quarterly. 

Internet address: http://artofmedicineimsj.us 

E-mail: info@artofmedicineimsj.us 

11931 Barlow Pl Philadelphia, PA 19116, USA +1 (929) 266-0862 

 

 
   

  



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CLINICAL AND IMMUNOLOGICAL INDICATORS OF INFLAMMATORY 

DISEASES OF THE NERVOUS SYSTEM 

M.Sh. Khozhimatova, N.A. Nasirdinova 

Andijan State Medical Institute 

Abstract: Inflammatory diseases of the central nervous system are severe 

processes with a wide range of pathogenetic disorders and lead to a gross deficiency 

in the nervous system or, in the worst cases, to the death of the patient. Acute 

inflammatory diseases of the central nervous system represent an extremely 

heterogeneous group of diseases and conditions in terms of clinical manifestations 

and prognosis, traditionally combined according to one of the main 

pathomorphological signs - primary demyelination. 

Keywords: primary, demyelination, diseases, clinical.  

Introduction: Clinical manifestations of inflammatory diseases of the central 

nervous system in the acute period to a certain extent depend on the tropism of the 

pathogen, the predominant localization of lesions and the characteristics of 

pathogenesis, as well as on the age of the patients. Despite the expansion of the 

diagnostic capabilities - neuroimaging, immunological studies, the possibility of 

carrying out these methods in the shortest possible time, there remain a number of 

unspecified questions both in the diagnosis and in the treatment of these diseases. 

In this regard, the goal was set for us: to study the clinical and immunological 

features of inflammatory diseases of the central nervous system and to optimize the 

diagnosis of these processes.  

Material and research methods: In the period from 2015 to 2020. 124 patients 

with acute inflammatory diseases of the central nervous system at the age from 18 to 

74 years were examined. The patients were observed in the neuro-intensive care units 

of the clinic of the Andijan Medical Institute. The comparison group consisted of 30 

apparently healthy people. All patients were divided into 3 groups depending on the 

localization of organic lesions of the central nervous system and the clinical 

diagnosis. Group 1 consisted of 34 patients with myelitis, group 2 of 58 patients with 

encephalitis and group 3 of 32 patients with encephalomyelitis. In all patients, the 

nosological forms were verified both clinically and neuroimaging (according to MRI 

data). 

                                                                                                     Table No. 1 

Distribution of patients depending on age 

Patient age 1st group 

Myelitis 

2 group 

encephalitis 

Group 3 

Encephalom

yelitis 

Healthy 

N % N % N % N % 

18-44 years 20 58,8 45 77,6 22 68,8 1

2 

40 

44-59 years 9 26,5 10 17,2 7 21,9 133,3 



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0 

60-74 years 5 14,7 3 5,2 3 9,3 8 26,7 

Всего 34 100 58 100 32 100 3

0 

100 

 

The distribution of patients depending on age indicates the predominance of 

patients from 18 to 44 years old in different age categories (patients with myelitis in 

this interval accounted for 58.8%, encephalitis 77.6%, encephalomyelitis 68.8%) 

(Table 1). 

The average age of patients at the time of examination was determined. 

According to statistical data, the average age of patients with myelitis was 39.2 ± 2.6 

years, the average age of patients with encephalitis was 37, 4 ± 1.7, and patients with 

encephalomyelitis, 37 ± 2.5. Studies have shown that most often inflammatory 

processes affect people of young and working age, which is consistent with the 

literature data. 

All patients underwent clinical neurological, laboratory, neuroimaging, 

immunological studies in order to determine the main mechanisms of the 

development of the disease. 

Of all the examined patients with encephalitis, 39 (67.2%) people had a severe 

and extremely difficult disease, 16 (27.6%) patients had a moderate form, a mild 

form of acute encephalitis in 3 (5.2%) patients ( table 2). 

In patients with myelitis, 8 (23.5%) patients had a severe course of the process, 

22 (64.7%) patients had a moderate course, and 4 (11.8%) patients had a mild course. 

Encephalomyelitis, as a more common and severe process, proceeded in the 

following indicators: extremely severe course in 8 (25%) patients, severe in 12 

(37.5%) patients and moderate in 12 (37.5%) people. 

Table No. 2 

The course of the inflammatory process depending on the disease 

 

№ Nosology The severity of the flow 



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Lung Average 

heavy 

Heavy Extremely 

heavy 

1 Myelitis 4   

(11,8%) 

22 

(64,7%) 

8   

(23,5%) 

- 

2 Encephalitis 3     

(5,2%) 

16 

(27,6%) 

29    

(50%) 

10 

(17,2%) 

3 Encephalomyelitis - 12 

(37,5%) 

12 

(37,5%) 

8      

(25%) 

 Total 7     

(5,6%) 

50 

(40,3%) 

49 

(39,5)% 

18 

(14,5%) 

 

Clinical and neurological research showed that in all study groups they had 

signs of organic lesions of the brain and spinal cord with a number of neurological 

symptoms in the form of bulbar disorders (in group 2 - 58.6%, in group 3 - 84.4%), 

pyramidal disorders ( in group 1 - 100%, in group 2 - 74.1%, in group 3 - 90.7%), 

pelvic disorders (in group 1 - 85.3%, in group 3 - 93.8%) (table No. 3). 

 

Table No. 3 

Comparative characteristics of the main neurological symptoms 

№ Neurological 

symptoms 

1 group 

(encephalomyelitis) 

2 group 

(encephalomyelitis) 

3 group 

(encephalomyelitis) 

1 Bulbar 

disorders 

- 34 (58,6%) 27 (84,4%) 

2 Convulsive 

syndrome 

- 23 (39,7%) 10 (31,2%) 

3 Cranial 

nerve 

damage 

- 17 (39,3%) 15 (46,8%) 

4 Pyramidal 

violations 

34 (100%) 43 (74,1%) 29 (90,7%) 

5 Sensory 

impairment 

34 (100%) 38 (65,5%) 30 (93,8%) 

6 Pelvic 29 (85,3%) - 30 (93,8%) 



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43 

disorders 

7 Intellectual 

impairment 

- 2 (3,4%) - 

 

Complications after a previous illness  

№ Nosology Vegeta 

tive 

(trophy 

ica

l) 

violation

s 

Epi 

lep 

thi

s 

Pa

resis and 

paralysis 

Ex

trapyra

mine 

disorder

s 

Co

ordinati

ng 

violation

s 

Pe

lvic 

dysfunct

ion 

1 Myelitis 33(97%) - 34(100%

) 

- 33(97,1

%) 

29(85,3

%) 

2 Encephalitis - 23(39,7

%) 

43(74,1

%) 

8(13,7%) 4(6,89%) - 

3 Encephalom

yelitis 

25(78,1

%) 

10(31,2

%) 

29(90,7

%0 

10(31,2

%) 

6(18,7%) 30(93,8

%) 

 Total 58(46,7

%) 

33(26,6

%) 

106(85,4

%) 

18(14,5

%) 

43(34,7

%) 

59(47,5

%) 

 

Complications after the previous illness among patients of all groups were 

observed more in the pyramidal, coordinating systems and pelvic disorders (diagram 

No. 1). Also, among patients with encephalitis and encephalomyelitis, the disease 

was complicated by epilepsy and amounted to 39.7% and 31.2%, respectively. 



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 Diagram No. 1 

 

 

 

 

 

 

 

 

Among patients with myelitis and encephalomyelitis, a large number (97% and 

78.1%, respectively) were trophic disorders, which, according to literature data, is 

associated with damage to the lateral horns of the spinal cord in inflammatory 

processes of the central nervous system. 

Here is an example: Patient K., born in 1984, was admitted to the neurology 

department of the AGMI clinic with a diagnosis of Acute meningoencephalitis. 

Complaints at admission: severe headaches, nausea, vomiting, fever up to 39 ° 

C, chills, pain throughout the body, weakness in the arms and legs on the left, 

drowsiness, general weakness. 

Anamnesis morbi: the patient considers himself ill for 10 days, the left 

extremities began to weaken on the sly, then he turned to a specialist, where he was 

urgently hospitalized. 

Status praesens: the general condition is more serious, is in an unconscious 

state. Visible skin and mucous membranes were unchanged. Peripheral lymph nodes 

are not enlarged. Breathing is even through the nose. Weak vesicular breathing is 

heard in the lungs. Heartbeats are rhythmic. HELL 140/90 mm Hg pulse 80 beats per 

0%

100%

200%

300%

400%

500%

600%

700%

800%

myelitis encephalitis encephalomyelitis

peat disturbances epilepsy paresis

extrapyramidal disorders coordinating violations Столбец1 



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minute. The tongue is clean, uncoated. The liver and spleen are not enlarged. 

Urination is carried out through a urinary catheter. 

Neurostatus: (given the serious condition of the patient) the pupils are 

uniformly narrow, photo reaction and corneal, conjunctival reflexes are weak. The 

face is symmetrical. There is no deviation. Motor sphere: there is a limitation of 

movement in the left limbs. Decreased muscle tone on the left. Tendon reflexes are 

triggered. Pathological reflexes: upper, lower Rossolimo, Babinsky on the left are 

positive. Sensitivity: the reaction is weak to external stimuli (needle prick). The 

coordination samples could not be verified. Meningeal signs: stiff neck, Kernig 

positive. There are no trophic changes. VND soporous state. 

Test results: 

1.  General analysis: Hb - 108 g / l, erythrocytes-3.74, Tsv.pok-0.8, 

leukocytes-25 g / l, ESR-25 mm / h, 

2. Analysis of cerebrospinal fluid: quantity-2.0, color-colorless, protein-6.6, 

cytosis-82, Pandey reaction - ++++, lymphocytic pleocytosis ,. 

3. ECG: sinus tachycardia, horizontal position of the electric axis of the 

heart. 

4. Biochemistry blood test: sugar -6.2 mmol, PTI-105%, INR-0.94, total 

bilirubin -36.54, bound-8.7, unbound-27.84, total protein -64.7, AST-1.2, ALT-1.5, 

5. Urine analysis: straw yellow color, protein - abs, leukocytes - 3-0-2. 

6. MRI of the brain: external dropsy of the brain, ventriculmegaly, 

hypotrophy of the cerebral cortex. Infiltration of the right hemisphere.  

Мрт расм 

Based on the history, clinical, MRI and laboratory findings, the following 

diagnosis was made: 

Acute encephalitis, viral etiology. 

Complication: left-sided hemiparesis. Edema of the brain. Sopor. Jacksonian 

seizures. 



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Treatment: was carried out according to the standard of treatment of the 

Ministry of Health of the Republic of Uzbekistan. 

1. Antiviral drugs 

2. Decongestants 

3. Drugs that improve microcirculation 

4. Neuroprotective agents 

5. Hormone therapy 

6. Antibiotic therapy 

7. Plasmapheresis 

In order to confirm the participation of the autoimmune component in the 

development of demyelination in patients with inflammatory diseases of the central 

nervous system, we examined the indicators of the following main cytokines: IL-1β, 

IL6, TNF-alpha (Table 4). 

Table No. 4 

Indicators of immunological research for encephalitis (pg / ml) 

№ Nosological 

forms 

 

The number 

of patients 

examined 

IL-1β   IL-6   TNF-

alpha 

  

CEC 

lar

ge 

C

EC small 

A

bs 

numbe

r 

% 

1 Encephalitis 2

0 

3

4,4 

13,

5±0,5 

*** 

8,4

±0,6** ^ 

7

,4±0,3 

12

4,1±1,8*

* 

12

7,7±1,8*

*^^ 

2 Myelitis 2

0 

5

8,8 

11,

8±06 

6,9

±0,3^ 

7

,4±0,4*

* 

10

2,5±1,7*

* 

10

1,8±1,3^

^ 

3 Encephalomy

elitis 
2

0 

6

2,5 

22,

9±1,0*** 

11,

0±0,4** ^ 

6

,6±0,4*

* 

13

2,7±2,3*

* 

13

0,6±3,0*

*^^ 

4 control 2

0 

6

6,7 

9,9

4  ± 

1,78*** 

3,4

2 ± 0,28^ 

4

,58 ± 

0,81** 

10

1±1,5** 

10

0±1,7** 

*** - P<0,001 between 1 and 3, 1 and 4 comparison group for IL -1β   

**   - P<0,01 between 1 and 3 comparison group according to IL-6   



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^     - P<0,001 between 2 and 3, 1 and 4, 2 and 4, 3 and 4 comparison group according to IL-

6   

**   - P<0,01 between 2 and 4, 3 and 4 comparison group for TNF-alpha 

*** - P<0,01 between 1 and 3, 2 and 3 by the CEC comparison group, large   

^^   - P<0,001 between 1 and 2, 2 and 3 comparison group by CEC small 

**   - P<0,01 between 1 and 3 comparison group according to the CEC small   

  

In all three observation groups, the above cytokines were also examined to 

determine the level of the autoimmune response. As can be seen from the data 

presented in the first group (encephalitis), the level of IL-1β was 2.5 times higher 

than the reference value and amounted to 13.5 ± 0.5. 

An increase in IL-1β was also observed in the groups examined with myelitis 

(11.8 ± 06 pg / ml) and encephalomyelitis (22.9 ± 1.0 pg / ml), and these indicators 

have a significant increase both between groups 1 and 3, and with the control group. 

In the study of the level of cytokines in the acute period of the disease, an 

increase in the production of IL-1β was observed in all studied groups, but it was 

significant in relation to the control group with encephalitis and encephalomyelitis 

(13.5 ± 0.5 pg / ml and 22.9 ± 1, 0 pg / ml, respectively). Moreover, with encephalitis 

and encephalomyelitis, this indicator was significantly higher than with myelitis, 

which once again proves the severity of these processes. It also correlates with both 

the course and clinical manifestations of the disease. 

When determining the level of IL-6, it was found that this indicator was 

significantly higher in all three groups compared with the control (8.4 ± 0.6 pg / ml 

with encephalitis, 6.9 ± 0.3 pg / ml with myelitis and 11 , 0 ± 0.4 pg / ml with 

encephalomyelitis). When comparing IL-6 between groups with diseases, it turned 

out that a significant increase was also observed between patients with encephalitis 

and encephalomyelitis. With encephalomyelitis, this indicator exceeded those with 

encephalitis (8.4 ± 0.6 pg / ml and 11.0 ± 0.4 pg / ml). This ratio corresponds to the 

severity and prevalence of the inflammatory process. 

The same tendency is characteristic of the tumor necrosis factor TNF-alpha - a 

cytokine, which usually increases during viral processes in the central nervous 

system, and also determines the immune response of the organism to pathogenic 



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processes. This indicator was significantly higher in all three groups with diseases 

compared to the control group (7.4 ± 0.3 with encephalitis, 7.4 ± 0.4 with myelitis, 

6.6 ± 0.4 with encephalomyelitis). However, this indicator in the comparison groups 

did not have a significant difference in increase, although it exceeded the indicators 

of the control group, but at the same time did not go beyond the limits of the 

reference value. 

Conclusions: 

1. Studies have shown that all inflammatory processes of the central nervous 

system are characterized by a predominance of severe (39.5%) and moderate (40.3%) 

forms of diseases, a high incidence of residual consequences (75%): in them, a 

chronic vegetative state was detected in 10% patients, symptomatic epilepsy - 26.6%, 

psychoorganic syndrome - 12.5%, coordination disorders - 34.7%, paresis and 

paralysis - 85.4% and others. 

2. The level of IL1-β, IL6, TNFa, CEC large and CEC small in acute 

inflammatory diseases of the central nervous system directly correlates with the 

severity of the course of the disease and the development of demyelination in the 

central nervous system (according to computed and magnetic resonance imaging), 

although according to TNFa indicators were in the study group were not reliable and 

did not exceed the reference values. 

3. Investigation of the level of circulating immunological complexes allows to 

determine the severity of the course of the disease and to predict the outcome in 

inflammatory diseases of the central nervous system.   

  



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