Dr. Kiking Ritarwan, MKT, SpS Myelitis Dr. Kiking Ritarwan, MKT, SpS

Myelitis Inflamation of the spinal cord I. Transverse Myelitis, II. Disseminata, III. Difussa Transverse myelitis (MYELOPATHY) is a syndrome characterized by acute spinal cord dysfunction both halves the cord in transverse section.

Myelitis transversalis inflamasi akut atau sub akut mengenai suatu area fokal di medula spinalis karakteristik klinis disfungsi neurologis pada saraf motorik, sensorik dan otonom dan traktus saraf di medula spinalis

MYELITIS CLASSIFICATION OF INFLAMMATORY DISEASE Gray matter…… Poliomyelitis. White matter …. Leukomyelitis. The whole crossectional are…Tranversemyelitis. Lesions are multiple and wide spreadOver a long vertical extent….. DiffuseOr Disseminated. Combined meninges and spinal cord…Meningomyelitis. Combined meninges and root--- meningpradiculitis. Inflammatory disease limited to the spinal dura…. Pachymeningitis. Infected material collects in the epidural or subdural space… Epidural spinal Or subdural spinal abcess or Granulomatous. CLASSIFICATION OF INFLAMMATORY DISEASE OF THE SPINAL CORD … SEE TRANSPARANTS

ACUTE TRANSVERSE MYELITIS IS USUALLY BILATERAL AND TENDS TO CAUSE MORE SEVERE WEAKNESS THAN THE TYPICAL ATTACKS OF PARTIAL MYELITIS. The condition may be peri infectious or postinfectious process and has been associated with many viral infection, including poliovirus, echovirus and coxsackieviruses.

Etiologie Transverse myelitis 1. Congenital – vascular malformation 2. Infectious – viral infection 3. Autoimune- peri or post infection or vaccinial myelitis. 4. Multiple sclerosis 5. Neoplastic 6. Toxic- secondary to heroin injection 7. Vascular 8. Degenerative- irradiation 9. Idiopathic.

PATOLOGI JHTMC (John Hopkins Transverse Myelitis Center)  kondisi inflamasi yang berhubungan dengan mekanisme immune-mediated Pasien myelitis transversalis perubahan inflamasi pada medula spinalisnya Abnormalitas patologi ( bervariasi ) infiltrasi lokal oleh limfosit dan monosit dalam segmen medula spinalis dan daerah perivaskuler adanya aktifitas yang bervariasi dari mikroglia dan astroglia

Besar dan luasnya gambaran inflamasi  faktor etiologi dan profile perubahan myelopati : Myelitis post infeksius  perubahan white matter, demielinasi, gangguan aksonal myelitis transversalis  gambaran yang melibatkan keduanya secara bersamaan baik white maupun grey matter

Viral causes of acute myelitis Herpesvirus: HSV2, Varicella Zoster, HSV1, Epstein barr, Cytomegalo, human herpes6. Enterovirus: Poliovirus, Enterovirus 70, Echovirus, Coxsackievirus. Arbovirus: west nile virus Other: Mumps, HIV, Dengue.

Affinities virus in myelitis Enterovirus anterior horn or nuclei of the brain stem Herpes zoster dorsal root ganglion

Clinical manifestation Acute paraplegic or Quadriplegic. Urinary retention. Sensory disturbances

Diagnostic prosedure CSF examination: - mild to moderate lymphocytic pleocytosis (10-1000 cell/mm3), elevated protein (100-500 mg/dl), and normal or mildly depressed glucose level. PCR- virus spesific PCR and antibody titer should be performed. MRI-T2 weighted shows increased signal intensity involving gray matter and surronding white matter.

PROSEDUR DIAGNOSTIK Dikutip dari : Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology 2002 ; 59 : 499 - 505

DIAGNOSIS BANDING : Multiple sclerosis Penyakit sistemik (SLE, Sjorgen disease) Venous infarct Malformasi vaskuler (fistula AV, AVM, angioma kavernosa) Fibrocartilagenous embolism Myelopati radiasi

Treatment Viral myelitis Antiviral treatment: Glucocorticoid Spasticity: baclofen (lioresal) 10 mg q6h, benzodiazepin and tizanidine.