Dr. Kiking Ritarwan, MKT, SpS

Presentasi berjudul: "Dr. Kiking Ritarwan, MKT, SpS"— Transcript presentasi:

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

2 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.

3 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

4 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

5 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.

6 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.

7 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

8 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

9 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.

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

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

12 Diagnostic prosedure CSF examination:
- mild to moderate lymphocytic pleocytosis ( cell/mm3), elevated protein ( 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.

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

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

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