Myelitis - ocw.usu.ac.idocw.usu.ac.id/.../bms166_slide_myelitis.pdf · Myelitis zInflamation of the spinal cord zI. Transverse Myelitis, II. Disseminata, III. Difussa zTransverse

MyelitisMyelitis

Dr. Kiking Ritarwan, MKT, SpS

Myelitis

Inflamation of the spinal cordI. Transverse Myelitis, II. Disseminata, III. DifussaTransverse 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

k kt i tik kli i di f i l i d f– karakteristik klinis disfungsi neurologis pada saraf motorik, sensorik dan otonom dan traktus saraf di medula spinalis

MYELITISMYELITISGray matter…… Poliomyelitis.White matter LeukomyelitisWhite matter …. Leukomyelitis.The whole crossectional are…Tranversemyelitis.Lesions are multiple and wide spreadOver a long vertical extent….. DiffuseOr Disseminated.DiffuseOr Disseminated.Combined meninges and spinal cord…Meningomyelitis.Combined meninges and root--- meningpradiculitis.Inflammatory disease limited to the spinal dura…. Pachymeningitis.y p y gInfected material collects in the epidural or subdural space… Epidural spinal Or subdural spinal abcess or Granulomatous.

CLASSIFICATION OF INFLAMMATORY DISEASEOF THE SPINAL CORD … SEE TRANSPARANTS

ACUTE TRANSVERSE MYELITIS

IS USUALLY BILATERAL AND TENDS TO CAUSE MORE SEVERE WEAKNESS THANCAUSE MORE SEVERE WEAKNESS THAN THE TYPICAL ATTACKS OF PARTIAL MYELITIS.The condition may be peri infectious or postinfectious process and has been

i t d ith i l i f tiassociated with many viral infection, including poliovirus, echovirus and coxsackieviruses.

Etiologie Transverse myelitis

1. Congenital – vascular malformation2 Infectious – viral infection2. Infectious viral infection3. Autoimune- peri or post infection or vaccinial myelitis.4 Multiple sclerosis4. Multiple sclerosis5. Neoplastic6. Toxic- secondary to heroin injection7. Vascular8. Degenerative- irradiation9. Idiopathic.p

PATOLOGI

JHTMC (John Hopkins Transverse Myelitis Center) JHTMC (John Hopkins Transverse Myelitis Center) kondisi inflamasi yang berhubungan dengan kondisi inflamasi yang berhubungan dengan y g g gy g g g

mekanisme mekanisme immuneimmune--mediatedmediated

Pasien myelitis transversalisPasien myelitis transversalis perubahan inflamasiperubahan inflamasiPasien myelitis transversalisPasien myelitis transversalis perubahan inflamasi perubahan inflamasi pada medula spinalisnyapada medula spinalisnya

Abnormalitas patologi ( bervariasi )Abnormalitas patologi ( bervariasi )Abnormalitas patologi ( bervariasi )Abnormalitas patologi ( bervariasi )–– infiltrasi lokal oleh limfosit dan monosit dalam segmen infiltrasi lokal oleh limfosit dan monosit dalam segmen

medula spinalis dan daerah perivaskuler medula spinalis dan daerah perivaskuler –– adanya aktifitas yang bervariasi dari mikroglia dan astrogliaadanya aktifitas yang bervariasi dari mikroglia dan astrogliay y g g gy y g g g

Besar dan luasnya gambaran inflamasi Besar dan luasnya gambaran inflamasi f k i l i d fil b hf k i l i d fil b hfaktor etiologi dan profile perubahan faktor etiologi dan profile perubahan myelopati :myelopati :

Myelitis post infeksiusMyelitis post infeksius perubahanperubahan white matterwhite matter–– Myelitis post infeksius Myelitis post infeksius perubahanperubahan white matterwhite matter, , demielinasi, gangguan aksonaldemielinasi, gangguan aksonal

–– myelitis transversalis myelitis transversalis gambaran yang gambaran yang yy g y gg y gmelibatkan keduanya secara bersamaan baik melibatkan keduanya secara bersamaan baik whitewhite maupun maupun grey mattergrey matter

Viral causes of acute myelitis

Herpesvirus: HSV2, Varicella Zoster, HSV1, E t i b C t l h h 6Epstein barr, Cytomegalo, human herpes6.Enterovirus: Poliovirus, Enterovirus 70, E h i C ki iEchovirus, Coxsackievirus.Arbovirus: west nile virusOth M HIV DOther: Mumps, HIV, Dengue.

Affinities virus in myelitis

Enterovirus anterior horn or nuclei of the b i tbrain stemHerpes zoster dorsal root ganglion

Clinical manifestation

Acute paraplegic or Quadriplegic.Urinary retention.Sensory disturbances

Diagnostic prosedure

CSF examination:ild t d t l h ti l t i (10 1000- mild to moderate lymphocytic pleocytosis (10-1000

cell/mm3), elevated protein (100-500 mg/dl), and normal or mildly depressed glucose level.y p g

• 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 DIAGNOSTIKPROSEDUR DIAGNOSTIK

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

DIAGNOSIS BANDING :DIAGNOSIS BANDING :

Multiple sclerosisMultiple sclerosisPenyakit sistemik (SLE, Sjorgen disease)Penyakit sistemik (SLE, Sjorgen disease)y ( , j g )y ( , j g )Venous infarctVenous infarctMalformasi vaskuler (fistula AV, AVM, angioma Malformasi vaskuler (fistula AV, AVM, angioma kavernosa)kavernosa)kavernosa)kavernosa)Fibrocartilagenous embolismFibrocartilagenous embolismMyelopati radiasiMyelopati radiasiyy

Treatment Viral myelitis

Antiviral treatment:GlucocorticoidSpasticity: baclofen (lioresal) 10 mg q6h, benzodiazepin and tizanidine.