Keywords: a case history, a neurology, an acute myelitis, neurology, myelit, nervous illnesses, an acute myelitis
the CASE HISTORY
the Clinical diagnosis: the Acute myelitis of a thoracal department
THE PASSPORT PART
- the Surname, a name a patronymic - ***********************.
- Age - 60 years.
- the Sex - man's.
- the Nationality - Russian.
- Formation - average.
- the Trade - the teacher of musical school.
- the Home address: ********************************************.
- Date of entering in clinic on March, 7, 2003.
COMPLAINTS
The patient complains of impossibility of movements of legs, on pains in distal departments of the bottom extremities (the middle of an anticnemion are lower), on feeling of a numbness in legs. Also the patient complains of impossibility of an independent emiction and a defecation, on absence of desires to natural departures.
The patient complains of pains in the field of 3 intercostal spaces at the left, irradiating in a back which sometimes migrate in corresponding area on the right.
ANAMNESIS MORBI
Counts itself the patient since March, 6, 2003 when the patient for the first time has noted delicacy in legs, feeling of a numbness, difficulty at walking. Gradually the symptomatology amplified, the condition of the patient worsened, he tested the big difficulties at walking, onychalgias have appeared. In the morning on March, 7 independent movement was impossible, is hospitalized in obshchenevrologicheskoe branch of a regional hospital. During occurrence of first attributes of disease of the patient was on treatment in Gribanovskoj hospital, in connection with a pneumonia.
The patient marks, that 2 years ago has visited road and transport incident - fracture of 2 ribs, strong pains in left to a side. Has received medical treatment in surgical branch Gribanovskoj hospital. Further - the condition has improved, the patient has returned to work. In October, 2002 after a frigorism whining pains in a thoracal cell at the left (" under ribs "), irradiating in area of a backbone have appeared. During 2002 the patient marked difficulty of outflow of urine. In December, 2002 at the patient the independent branch of urine has stopped. On December, 28 it is hospitalized in Gribanovskuju hospital where the diagnosis an adenoma of prostatic Ferri lactas is put. After the lead treatment - improvement of a condition. On January, 15, 2003 the patient has returned to work, but pains in a side amplified, to work it became hard also he have been compelled to address in hospital where the diagnosis has been put: a pneumonia. On a background of the appointed treatment - improvement of a condition, decrease of pains in a thoracal cell. The pneumonia proceeded without a fervescence.
ANAMNESIS VITAE
Was born in 1942 in the Voronezh area in country family. Dews also developed in conformity with the years. Works at school as the teacher of music (the instrument - the bayan), denies professional harmfulnesses. Does not smoke, the use of alcohol - moderate, the use of narcotics denies.
During life has transferred the following diseases: an acute infection, ORVI, a flu. Has transferred 2 operations concerning a hernia: in 1998 and in 2002. In 2000 - fracture of ribs as a result of road accident, in 2002 - an adenoma of prostatic Ferri lactas, January, 2003 - a pneumonia. In connection with a pneumonia accepted gentamycin.
A tuberculosis, an infectious disease, an epilepsy, mental and venereal diseases at itself and relatives denies. Badly transfers substances to pungent smells (camphor alcohol) - at the patient develop an attack of a rhinitis, tussis. Allergic reactions to other medicinal substances, food stuffs denies
STATUS PRAESENS COMMUNIS
the General survey of the patient.
The general condition of the patient serious. Consciousness clear. A position in bed - passive, a look - quiet. Type of a body build - normostenik. Body height - 178 sm, mass of a body - 75 kg.
Integuments of bronze color (the patient marks appreciable insoljatsionnyj the factor in an anamnesis), dry, without rashes. On external surfaces of anticnemions there are sites of a depigmentation. The turgor of a skin normal, a skin elastic, nails of the usual form, a scalp is normally advanced.
Submandibular lymph nodes, umerennoplotnye, painless, in size with a pea, mobile, not commissured among themselves and with environmental tissues are palpated. The skin above them is not changed. Other peripheric lymph nodes are not palpated.
The muscular system is normally advanced. Force of muscles in the top extremities - 5 points, a tone of muscles sufficient. A head and extremities of the usual form, the backbone is not deformed. Joints are mobile, painless at a palpation, integuments in the field of joints are not changed.
A body temperature at the moment of a curatio - 37,3 ° Ñ.
System of organs of respiration.
The form of a thoracal cell - correct, is present deformation of the left ribs owing to the transferred fracture. Respiration deep. Frequency of respiratory movements - 16-18 in one minute. At a palpation morbidity is taped in the field of 3 intercostal spaces at the left. A percussion sound on symmetric sites of a thoracal cell identical, character of a sound - clear pulmonary. Intercostal spaces are not expanded. Intensifyings of a voice tremor are not present. Above all pulmonary fields - a clear pulmonary sound. Borders mild according to norm.
At an auscultation above pulmonary fields vesicular respiration is auscultated. Bronchial respiration is auscultated above a larynx, a trachea and large bronchuses. Bronhovezikuljarnoe respiration is not auscultated. Rhonchuses, are not present a crepitation. Intensifyings of a bronchophony are not present.
System of organs of a circulation.
The cardiac jerk is not determined, the thoracal cell in a place of a projection of heart is not changed, the apical jerk visually is not determined, systolic vtjazhenija the intercostal area on a place of an apical jerk is not present, pathological pulsations are not present. The apical jerk is determined in V an intercostal space. Border of relative dullness of heart - within the limits of norm. At an auscultation - cardiac tones clear, rhythmical. A seen pulsation of carotids and bulbar veins it is not noticed. Frequency ïóëüñà=÷àñòîòå cardiac ñîêðàùåíèé=82 impact in one minute on both arms. Deficiency ïóëüñà=0. a blood pressure - 140/90 mm Hg.
System of organs of digestion.
A mucosa of an oral cavity and a pharynx pink, clean, dryish. Tongue wet with a yellow raid, gustatory papillas are well expressed. The dentition is not kept. Angles of labiums without cracks. The forward abdominal wall intense, does not participate in the act of respiration. At a palpation of morbidity of muscles is not present, the prelum abdominale is advanced moderately, the divarication of recti is absent, the umbilical ring is not enlarged, the sign of fluctuation is absent.
The bottom edge of a liver rounded, painless, acts on 1 sm from under a costal arch. The sizes of a liver on Kurlovu 11ñì, 10 sm, 8 see. The lien palpatorno is not determined.
System of a uropoiesis.
At survey of lumbar area of a tumescence, a protrusion it is not revealed. Kidneys are not palpated. A sign of a beating on lumbar area negative from both sides. Sexual system - without features. Owing to impossibility of an independent emiction of the patient kateterizirovan.
Endocrine system.
A thyroid gland: not enlarged isthmus is palpated. Signs of a hyperthyroidism and a hypothyroidism are absent. Changes of the person and extremities, characteristic for an acromegalia are absent. Infringements of weight (an obesity, an attrition) are not present. Integuments of bronze color. The scalp is advanced normally, abaissement of hair is not present.
STATUS SPECIALIS
Craniocerebral nerves:
I a steam. The olfaction is kept, dysosmias, are not present olfactory hallucinations.
II steam. Vision +2 (hypermetropia). Abaissements of a field of vision it is not revealed. A color perception - normal.
III, IV, VI steams. Pupils of the correct form, sizes, uniform. A straight line and sodruzhestvennaja reaction of pupils to light alive symmetric. The volume of movements of eyeglobes complete, is not present a strabismus, the nystagmus is not present. Assay on a convergence and an accommodation is not broken. A sign Gref negative. The sign of "rising sun" is not determined.
V a steam. The patient marks parestezii in the field of a lower lip on the right (in a point of an output of a mandibular branch of a trigeminal nerve). In other part of the person superficial and deep sensitivity is kept, points of an output of a trigeminal nerve are painless, corneal and konjuktivalnyj reflexes are kept.
VII steam. Palpebral fissures and are symmetric to a brow, frontal and nosogubnye skladki are uniform, the person symmetric at namorshchivanii a forehead, nahmurivanii brows, zazhmurivanii an eye, oskalivanii teeth, naduvanii cheeks. Taste on lobbies 2/3 tongues is kept, a cornea of an eye humidified.
VIII steam. The hearing is not reduced. SHepotnuju speech from 6 meters perceives. In view of a passive position of the patient the simple and complicated poses Romberga were not carried out. It is taped melkorazmashistyj an end-position nystagm.
IX, X steams. A voice of the patient silent, but equal, without a dysarthtia. Taste on back 1/3 tongues is kept. A swallowing free, painless. The soft palate is mobile, symmetric. Reflexes from a soft palate and a back wall of a pharynx are kept.
XI steam. Turns of a head in the sides and downwards and a raising of brachiums in full without difficulties.
XII steam. Tongue is mobile, deviation of the put out tongue is not present, the atrophy of muscles of tongue is not present. Speech is not changed.
Impellent sphere.
Atrophies and myopachynsises, fastsikuljarnyh and fascial twitchings, hyperkinesias it is not revealed. A muscle tone in norm in all groups of muscles.
The spastic paraparesis of the bottom extremities, pains in distal departments of legs (the middle of anticnemions are lower), feeling of a numbness is observed. The patient in a condition actively to move with fingers on the left leg.
Force of the top extremities - 5 points D=S. Force of the bottom extremities: sgibateli left stops - 2 points, sgibateli right stops - 1 point. Extensors left stops - 3 points, extensors right stops - 1 point. Extensors of an anticnemion at the left - 2 points, on the right - 1 point. Sgibateli anticnemions at the left - 3-4 points, on the right - 1-2 points.
Volume of active movements in joints of the top extremities (a flexion and an extension of ulnar and radiocarpal joints, compression and a release of fists, abductio et adductio fingers of a brush, opposition of the big finger) - complete. Active movements in joints of legs - are impossible. The volume of passive movements in joints of the bottom extremities circumscribed. Kontraktur and ankyloses it is not revealed.
The patient has global synkineses - reduction of a hip (it is more expressed for the right extremity), a flexion stops (is approximately identical to both extremities).
Paltsenosovaja assay - without features.
Reflexes:
Proprioceptive reflexes in the field of the person (nadbrovnyj, mandibular) are moderately expressed, are caused easily, in the field of arms (sgibatelno-ulnar, razgibatelno-ulnar, karpo-radial) are moderately expressed, the zone of a reflex is not expanded, D=S; Mayer reflexes and Leri are not caused. Knee reflexes bright, on the right are higher, than at the left; the zone of a reflex is expanded: it is caused from lateral surfaces of a joint, and also with nadkolennika and the distal end m.quadricipitis femoris. Ahillov the reflex also bright, on the right is higher, than at the left. On right stop it is determined klonus, on left - klonoid.
Exteroceptive reflexes: corneal and pharyngeal are moderately expressed, identical from both sides; the top, average and bottom belly reflexes otstutstvujut. The plantar reflex is submitted by pathological sign Babinskogo on the right and at the left.
Pathological reflexes: Rossolimo - is not present; Babinskogo - positive D=S; CHuraeva - is not present; Gordona - is not present; Bekhterev - Mendel - is not present; Oppengejma - is not present; ZHukovskogo-Kornilova - is not present; SHeffera - is not present.
Sensitive sphere.
Downstroke of all kinds of sensitivity below a level of a costal arch is taped. I.e. at the patient bilateral frustration of superficial kinds of sensitivity on conduction type is observed.
Infringements of 3 measured feelings are taped on fingers of the bottom extremities (D*lt; S). The patient marks feeling of a numbness in the bottom extremities. Sign Lasega is taped. The palpation in points of an occipital nerve, a humeral plexus (point Erba), juxtaspinal points, on a course of intercostal nerves, on a course of sciatic nerve (Valle), in points of an output of a trigeminal nerve is painless.
Vibratory sensitivity was not investigated in connection with absence of a tuning fork.
Above a level of a costal arch all kinds of sensitivity are kept.
Meningialnye signs (the stiff neck, sign Brudzinskogo, a Kernig's sign) are absent.
Functions of pelvic organs:
The patient 6.03.03 had ischuria concerning what the catheterization is made, the periodic incontience of urine since then is observed - the constant catheter is put. Desires on an emiction of the patient does not feel. At statement of a catheter also did not feel his passage on mocheispuskatelnomu to the canal. Control the act of an emiction of the patient cannot. The patient marks, that since same time (6.03.03) frustration of a defecation take place: impossibility of an independent defecation with periodic consensual branch of fecal masses. Desires on a defecation are absent.
Vegetative nervous system.
The skin of bronze color, nails of the usual form, a diaphoresis usual, a dermographism red, a pupil changes diameter depending on illuminating intensity. On a skin of anticnemions and stop there are trophic changes as a hyperpegmentation. The moderate Crocq's disease is observed. ×ÑÑ=82 ud/minutes. Simpatalgy is not present, a solar plexus painless. Frustration of a diaphoresis, a salivation are not present. An Aschner's reflex: decrease of a heart rate with 82 up to 74 impacts 1 minute. Set of symptoms Gornera is not present. Ortoclinostatic assay was not carried out in connection with a passive position of the patient. Diencephalic signs it is not revealed. The body temperature in an axillary fossa makes 37,2°Ñ.
Mentality.
In a place, time and own person of the patient it is focused. The patient kontakten, is critical to the condition. The patient understands the inverted speech, correctly determines environmental subjects, perceives simple and compound sentences Memory on recent and for a long time past events is kept. Intelligence in conformity with the years and formation. The person of the patient is kept. Mood - equal. Dream - restless, sick frequently wakes up. Frustration of perception, thinking, will it is not observed.
Speech precise, clear, distinct. Offers are logically constructed. Motor, sensory and amnesticheskoj aphasias it is not revealed. Agrafii, alexias, acalculias it is not observed. Ideatornaja and the constructive apraxia is not revealed.
THE PRELIMINARY DIAGNOSIS
An acute myelitis of a thoracal department.
THE PLAN OF INSPECTION
- the general analysis of a blood,
- the biochemical analysis of a blood,
- the general analysis of urine,
- RKT or MRT spinal and a brain,
- research of a cerebrospinal liquid,
- consultation of the urologist,
- consultation of the oncologist.
LABORATORY AND TOOL METHODS OF RESEARCH
the General analysis of a blood:
the Haemoglobin (Hb) - 131 g/l
Erythrocytes - 4,2*1012/ë
Leucocytes - 12,2*109/ë:
eosinocytes - 3 %;
relating to stab neutrophile neutrophils - 9 %;
segmentojadernye neutrophils - 51 %;
lymphocytes - 36 %;
monocytes - 11 %;
a sedimentation rate - 20 mm / ch.
the Biochemical analysis of a blood:
the Glucose - 4,5 mmole/l (N=3,3-5,5)
the Urea - 6,3 mmole/l (N=3,3-6,6)
Amilaza - 4,0 (N=2,2-7)
AlAT - 55 nmole/l (N=27,8-125)
AsAT - 31 nmole/l (N=27,8-189)
the Bilirubin free - 9 (N=5-20,5)
the General analysis of urine:Urine muddy, color - yellow, relative density - 1017, reaction - acidic, fiber - 1 g/l. It is not enough epithelium, leucocytes - 1-2 in sight, erythrocytes - 1-2 in sight, bacteria are not present.
At RKT a thoracal and lumbar department of a backbone, a spinal cord in this department, pelvic bones of traumatic damages, tumours, metastasises of tumours, abscesses, the centers of hemorrhages, developmental anomalies it is not revealed.
Ultrasonic of prostatic Ferri lactas:
The volume of prostatic Ferri lactas makes about 80 sm3, the sizes 73´36 mm. Ehostruktura diffuse with the centers gipoehogennosti.
Histological research of a tissue of prostatic Ferri lactas: a cancer of prostatic Ferri lactas.
THE TOPICAL DIAGNOSIS AND HIS SUBSTANTIATION
Recognizing that at the patient the spastic paraparesis of the bottom extremities is observed, positive sign Babinskogo, intensifying knee and ahillovyh reflexes with expansion of a reflexogenic zone, klonus on right stop and klonoid - on left are taped, frustration of an emiction and a defecation on the central type take place (the impossibility of an independent emiction and a defecation, absence of desires), is determined not dissociated frustration of sensitivity on conduction type (downstroke of all kinds of sensitivity below a level of a costal arch), are observed vegetative - trophic frustration, is possible to draw a conclusion on bilateral transversal defeat of a spinal cord at a level of a thoracal department, segments Ò5-Ò6.
THE CLINICAL DIAGNOSIS AND HIS SUBSTANTIATION
The diagnosis of an acute myelitis can be put on the basis:
complaints of the patient:on a pain in distal departments of the bottom extremities (the middle of an anticnemion are lower), on feeling of a numbness in legs, impossibility of independent departure of natural functions, absence of desires on an emiction and a defecation;
a clinical picture:
A peripheric paraparesis of the bottom extremities,
Infringement of functions of pelvic organs (impossibility of an independent emiction and a defecation),
Abaissement of all kinds of sensitivity is lower than a level of a costal arch,
A fervescence up to 38,5°Ñ,
the data of an anamnesis:disease has developed on a background of an allowed pneumonia (it is possible to assume a secondary myelitis as complication of a pneumonia as a result of pathological autoimmune reaction or hematogenous drift of an infection in a spinal cord; on the basis of the data epidemiologii about constant augmentation of a share mikoplazmennyh pneumonias in a population, taking into account that fact, that one of the most often complications mikoplazmennyh pneumonias is defeat of a spinal cord as a myelitis, it is possible to assume, what exactly this originator is the reason of disease, however for the exact diagnosis abjection of the originator is necessary), clinical displays of the given disease have reached a maximum for 3 day
the given additional methods of research:are taped a leukocytosis (12,2´109/ë), rising of a sedimentation rate up to 20 mm / ch.
THE DIFFERENTIAL DIAGNOSIS
The acute myelitis is necessary for differentiating with epiduritom, an acute polyradiculoneuritis to Gijena-Barra, tumours of a spinal cord, acute infringement of a spinal circulation, a multiple sclerosis, a chronic meningomyelitis, traumatic damage of a spinal cord.
As against an acute myelitis for epidurita presence of a suppurative focus in an organism, occurrence of radicular pains, a set of symptoms of an increasing compression of a spinal cord is characteristic.
The acute polyradiculoneuritis to Gijena-Barra differs from a myelitis absence of conduction infringements of sensitivity, the spastic phenomena and pelvic frustration.
For tumours of a spinal cord typically slow current, presence of a belkovo-cellular dissociation in a cerebrospinal liquid, the trochlea at liquorodynamic assays. A hematomyelia and gematorahija arise suddenly, are not accompanied by rise of temperature; at a hematomyelia the grey substance is amazed basically; if the hemorrhage has taken place under environments there are meningeal signs. In an anamnesis frequently it is possible to reveal indicatings on a trauma.
At a multiple sclerosis selective defeat of white substance, frequently fast and appreciable retrogress of signs in some days or weeks, presence of attributes of absent-minded defeat spinal and a brain is characteristic.
The chronic meningomyelitis differs slower development, absence of rise in temperature and is quite often caused by syphilitic defeat that is established with the help of serological tests.
THE FINAL DIAGNOSIS
An acute myelitis of a thoracal department (segments T5-T6) (G04 on ÌÊÁ-10). A cancer of prostatic Ferri lactas.
THE DIARY OF THE PATIENT
On March, 10. A condition of the patient serious. The patient complains of impossibility of active movements by the bottom extremities, impossibility of independent departure of natural functions, on absence of desires on an emiction and a defecation. Not dissociated infringement of sensitivity below a level of a costal arch is taped. A body temperature=37,1°Ñ.
On March, 11. The condition of the patient remains serious. The patient is irritable, slept badly because of pains in distal departments of the bottom extremities. The patient complains of impossibility of active movements by the bottom extremities, impossibility of independent departure of natural functions, on absence of desires on an emiction and a defecation. Infringement of sensitivity below a level of a costal arch is taped. A body temperature=36,8°Ñ.
On March, 12. The condition of the patient remains serious, but the patient marks some improvement of state of health. The patient complains of difficulty of active movements by the bottom extremities, impossibility of independent departure of natural functions, on absence of desires on an emiction and a defecation. It is marked, that the volume of carried out movements has increased. The patient in a condition actively to move with fingers of both legs, independent movements by the left anticnemion in small volume are possible. Infringement of sensitivity below a level of a costal arch is taped. A body temperature=37,0°Ñ.
TREATMENT
the Treatment planning:
Antibiotics of a wide spectrum of action for liquidation of the infectious center and inhibition of bacterial aggression. It advisable tsefalosporiny III (are more comprehensible under the price) or IV generations as they have a wide spectrum of antibacterial action, a high bactericidal action, rather a hypotoxicity, a resistance to a staphylococcal penicillinase, high activity concerning steady against Penicillinums of staphylococcuses. The additional factor for the benefit of purpose tsefalosporinov III-IV generations is that they will well penetrate through GEB into a CNS (treatment of an acute myelitis), and also, that they reach the maximal concentration in a renal tissue (prophylaxis of an ascending infection which probability is high in connection with presence at a sick constant urinary catheter).
The glucocorticoid Hormonums having expressed anti-inflammatory action.
Vitamins of group In, improving metabolic processes in a nervous tissue.
Immunomoduljatory - for correction of the immune status.
Passive LFK for the prevention of development kontraktur since the first day of illness. Massage.
Prophylaxis of decubituses: laying of the patient on a circle, podkladyvanie under pjatki wadded linings, daily wiping of a body by alcohol (taking into account, that the camphor patient does not transfer, it is possible to recommend etilovyj or salicylic). If the opportunity allows, in the same purposes carry out a ultra-violet irradiation of breeches of a sacrum, stop.
An obligatory lavage kateterizirovannogo a bladder antiseptic solutions.
A sheet of purposes:
- Sol. Ceftriaboli 1,01,0 v/v
- Sol. Dexamaethasoni 0,04 - 1 ml 1,0 v/m
- Derinat 0,15 - 2 ml 2,0 v/m
- Sol. Tiamini chloridi 2,5 % - 1 ml 1,0 v/m
THE EPICRISIS
************************** 60 years, has acted in obshchenevrologicheskoe branch OKB ¹1 with complaints to impossibility of movements of legs, to pains in distal departments of the bottom extremities (the middle of an anticnemion are lower), on feeling of a numbness in legs, on impossibility of an independent emiction and a defecation, on absence of desires to natural departures, on a pain in the field of 3 intercostal spaces at the left, irradiating in a back which sometimes migrate in corresponding area on the right.
From an anamnesis it is known, that before entering in the central hospital ¹1 was on treatment in hospital concerning a pneumonia where the above described clinical picture within 2 day has developed.
The total anaesthesia below a level of a costal arch, rising knee and ahillova a reflex, klonus, a positive Babinski's reflex on the right is objectively taped. The spastic paraparesis of the bottom extremities is observed.
The cancer of prostatic Ferri lactas confirmed with histological research is revealed.
A body temperature 37,3°Ñ, a leukocytosis (12,2´109/ë), rising of a sedimentation rate up to 20 mm / ch.
The diagnosis an acute myelitis of a thoracal department with defeat of a spinal cord at level T5-T6. is put
Treatment tseftriabolom, by Dexamethazonum, derinatom, Thiaminum is lead. During stay in a hospital retrogress of a neurologic symptomatology, downstroke of a body temperature is marked, subjectively the patient marks some improvement.
THE FORECAST
à) for life - rather favorable, however taking into account, that at the patient the cancer of prostatic Ferri lactas - doubtful is revealed;
á) for complete convalescence - doubtful (the residual phenomena are possible);
â) for a working capacity - doubtful.
THE ETIOLOGY AND THE PATHOGENY OF DISEASE
A myelitis - an inflammation of a spinal cord at which it is amazed both white, and grey substance. Allocate infectious, intoksikatsionnye and traumatic myelites. Infectious myelites can be the initial, caused neuriviruses (Herpes zoster, viruses of a poliomyelitis, a rabies), the caused tubercular or syphilitic defeat. Secondary myelites arise as complication obshcheinfektsionnyh diseases (a scarlatina, a typhoid, a pneumonia, a flu) or any suppurative focus in an organism and a sepsis. At initial infectious myelites the infection is distributed gematogenno, to defeat of a brain precedes viremija. In a pathogeny of secondary infectious myelites play a role autoimmunnnye reactions and hematogenous drift of an infection in a spinal cord. Intoksikatsionnye myelites meet seldom and can develop owing to serious exogenous poisonings or an endogenic intoxication. Traumatic myelites arise at the open or closed traumas of a backbone and a spinal cord with connection of a secondary infection. Cases of a postvaccinal myelitis are frequent.
THE LIST OF THE LITERATURE
- Gusev E.I., Konovalov A.N., Burd G.S.neurolog and neurosurgery: the Textbook. - M.: Medicine, 2000. - 656 s.: an ooze. - (Studies. Lit. For students medvuzov).
- A.V.topical's Triumphes diagnostics of diseases of nervous system: M.: Open Company " Ìåäïðåññ ". - 1998. - 304 with.
- Skoromets A.A., Skoromets T.A.topical diagnostics of diseases of nervous system: the Management for doctors. - 3 edition corrected and added - SPb.: Polytechnics, 2000. - 399 with.: an ooze.
- RLS - the Encyclopedia of medicines. Under G.L.Vyshkovskogo's edition - Ì., 2002.
- the Circuit of a case history developed on faculty of a neurology VSMA by him. Burdenko.
- Lectures on a neurology.
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Keywords: a case history, a neurology, an acute myelitis, neurology, myelit, nervous illnesses, an acute myelitis
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