Trauma Medula Spinalis Dimas

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 TRAUMA MEDULA TRAUMA MEDULA

SPINALISSPINALIS

Dimas Noor Zulfkar FauziFebrina Sylva

Abraam Emes

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DefnisiDefnisi

!e"era me"ula s#inalis a"ala$e"era a%au kerusakan #a"a

me"ulla s#inalis yan&

menyebabkan #erubaan'un&sional( baik se$arasemen%ara a%au #ermanen #a"a

'un&si mo%orik( sensorik( a%auo%onom)

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E%iolo&iE%iolo&i

*er"asarkan e%iolo&i %erba&i men+a"i!e"era %rauma%ik

!e"era non.%rauma%ik

. kanker

. &an&&uan #embulu "ara

. ra"an&/in'eksi

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Pa%o&enesisPa%o&enesis

!EDERA PRIMER0ERUSA0AN ME0ANIS / FISI0 

!EDERA SE0UNDER

NE!R1SIS PR12RESSIF SU*S) AL*A3 2RISEA

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!EDERA PRIMER!EDERA PRIMER

Akiba% %ena&a mekanis %rauma %er+a"i "es%ruksineuron

Dalam 4ak%u 56 meni% #as$a $e"era( #er"araan#%e$ie b&n sen%ral masa abu.abu( mula, #a"a

$ornu an%erior "an seki%ar $analis sen%ralis) Sa%u +am kemu"ian "ara berkum#ul "i $ornu

#os%erior "an masa #u%i ,+am #as$a $e"era- invasi sel, in7amasi

8+am #as$a $e"era- am#ir se#arume")s#in)nekro%ik

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9 +am #as$a $e"era- %r+" oe"em

#rimer vaso&enik8: +am Pas$a $e"era- akan %er+a"i

oe"ema "an nekro%ik $rosseksional

#a"a %em#a% $e"era

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!EDERA SE0UNDER!EDERA SE0UNDER

Meru#akan #erubaan #ro&resi'

#a%olo&is "an fsiolo&is se%ela $e"erneuron #rimer

Mekanismenya karena-

Ra"ikal bebas

!a me%as%ase

Pro&ramme" sel "ea% a%au a#o#%osi

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0lasifkasi0lasifkasi

*er"asarkan klasifkasi ASIA "anIMS1P( %erba&i men+a"i

2RADE A- $om#le%e( 'un&si mo%orik /sensorik ;.<s/" se&men S8.S=

2RADE *-in$om#le%e( 'un&sisensorik;.<( 'un&si mo%orik masi ;3<"iba4a level u"ara s#inal s/"se&men S8.S=

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2RADE !-in$om#le%e ( 'un&sisensorik ;3<( 'un&si mo%orik masi

;3<"i ba4a level $e"era s#inal"an seba&ian besar >6 o%o%eks%remi%as "i ba4a level $e"era

s#inal #unya kekua%an mo%orik ?52RADE D-in$om#le%e( 'un&sisensorik ;3<( 'un&si mo%orikmasi ;3<"i ba4a level $e"era

s#inal "an seba&ian besar >6 o%o%eks%remi%as "i ba4a level $e"eras#inal #unya kekua%an mo%orik @5

2RADE E-normal ( mo%orik "ansensorik normal

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Complete cord transectionComplete cord transection

!e"era kom#li% #a"a $ervi$al -

• Mo%orik

 Te%ra#le&ia

• SensorikAnes%esia

• 1%onom

i#o%ensi "an i#o%ermia %an#a%akikar"ia kom#ensasi ;So$kNeuro&enik<

Res#ira%ory arres%

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!e"era kom#li% #a"a %orakal "an lumbal -

•

Mo%orikPara#le&ia

• Sensorik

Anes%esia "i ba4a level $e"era

• 1%onomilan& %onus re$%um "an vu

Re%ensio urin

Ileus

Pria#ismus

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!en%ral $or" syn"rome!en%ral $or" syn"rome

Mo%orik Para#arese ;eB% a%as lebi bera%<

Sensorik 2an&&uan minimal ;Sa4l.like

syn"rome<

1%onom

  Re%ensio urin

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An%erior $or" syn"romeAn%erior $or" syn"rome

Mo%orik Paralisis

Sensorik 2an&&uan minimal #a"a 'un&si

#ro#iose#%i' 

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Pos%erior $or" syn"romePos%erior $or" syn"rome

Mo%orik Para#arese

Sensorik 2an&&uan #ro#iose#%i' 

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*ro4n.SeCuar" syn"rome*ro4n.SeCuar" syn"rome

Mo%orik Para#arese i#sila%eral

Sensorik 2an&&uan #ro#iose#%i' i#sila%eral(

kon%rala%eral normal)

  2an&&uan ek%erose#%i' kon%rala%eral)

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!onus.me"ulary!onus.me"ulary

syn"romesyn"rome Mo%orikMo%orik 2an&&uan %i#e LMN2an&&uan %i#e LMN

SensorikSensorik Anas%esia "iAnas%esia "i saddlesaddle areaarea

1%onom1%onom  Re%ensio urinRe%ensio urin

  2an&&uan "e'ekasi2an&&uan "e'ekasi

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Pena%alaksanaanPena%alaksanaan

Umum-. %era#i emer&en$y "& mem#era%ikaA*!( immobilisasi "an %rans'er #asien

. %era#i masala umum se#er%i &&nres#irasi( kar"iovaskuler "an&as%roin%es%inal

. s%abilisasi s#inal

. "ekom#resi be"a bila a"a in"ikasi

. #ro&ram reabili%asi

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Cegah hilangnya fungsi motorik permanen. Pemberian steroid segera.

Kejadian sebelum 8 jam:metil prednisolon do tinggi 30 mg/kgBB i..

 perlahan !" menit 

#" menit kemudian infus "$# mg/kgBB selama %3 jam.

&ika 'edera terjadi antara 3(8 jam infus berakhir s/d#8 jam.

)anitol 0$%"(!$0 gr/kgBB mengobati edema )*. +angguan pernafasan pada 'edera serikal 

 pera,atan -C. *el(sel dengan 'edera ringan mungkin melakukan

respons adaptif pemberian obat(neuro protektif.

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Pera4a%an Umum-#era4a%an kan"un& kemi

#era4a%an rek%um

#era4a%an kuli%nu%risi

kon%rol nyeri

#era4a%an #sikia%rireabili%asi