Myelitis
Dr. Kiking Ritarwan, MKT, SpS
Myelitis z z z
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.
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Myelitis transversalis – – –
inflamasi akut atau sub akut mengenai suatu area fokal di medula spinalis k kt i tik kli karakteristik klinis i di disfungsi f i neurologis l i pada d saraff motorik, sensorik dan otonom dan traktus saraf di medula spinalis
MYELITIS Gray matter…… Poliomyelitis. White matter …. Leukomyelitis. 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 y disease limited to the spinal p dura…. Pachymeningitis. y g 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 z
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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 i t d with ith many viral i l iinfection, f ti including poliovirus, echovirus and coxsackieviruses.
Etiologie Transverse myelitis z z z z z z z z z
1. Congenital – vascular malformation 2 Infectious – viral infection 2. 3. Autoimune- peri or post infection or vaccinial myelitis. 4 Multiple sclerosis 4. 5. Neoplastic 6. Toxic- secondary to heroin injection 7. Vascular 8. Degenerative- irradiation 9. Idiopathic. p
PATOLOGI z
JHTMC (John Hopkins Transverse Myelitis Center) Æ kondisi inflamasi yyang g berhubungan g dengan g mekanisme immune immune--mediated
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Pasien myelitis transversalisÆ transversalisÆ perubahan inflamasi pada medula spinalisnya
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Abnormalitas patologi ( bervariasi ) – –
infiltrasi lokal oleh limfosit dan monosit dalam segmen medula spinalis dan daerah perivaskuler adanya y aktifitas y yang g bervariasi dari mikroglia g dan astroglia g
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Besar dan luasnya gambaran inflamasi Æ f k etiologi faktor i l id dan profile fil perubahan b h myelopati : –
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Myelitis post infeksius Æ perubahan white matter matter,, demielinasi, gangguan aksonal myelitis y transversalis Æ g gambaran yyang g melibatkan keduanya secara bersamaan baik white maupun grey matter
Viral causes of acute myelitis z z z z
Herpesvirus: HSV2, Varicella Zoster, HSV1, E t i barr, Epstein b C Cytomegalo, t l h human h herpes6. 6 Enterovirus: Poliovirus, Enterovirus 70, E h i Echovirus, C Coxsackievirus. ki i Arbovirus: west nile virus Oth Mumps, Other: M HIV, HIV Dengue. D
Affinities virus in myelitis z z
EnterovirusÆ anterior horn or nuclei of the b i stem brain t Herpes zosterÆ dorsal root ganglion
Clinical manifestation z z z
Acute paraplegic or Quadriplegic. Urinary retention. Sensory disturbances
Diagnostic prosedure z
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CSF examination: - mild ild tto moderate d t llymphocytic h ti pleocytosis l t i (10 (10-1000 1000 cell/mm3), elevated protein (100-500 mg/dl), and normal or mildlyy depressed p g 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 : z z z z z z
Multiple sclerosis Penyakit y sistemik ((SLE,, Sjorgen j g disease)) Venous infarct Malformasi vaskuler (fistula AV, AVM, angioma kavernosa) Fibrocartilagenous embolism Myelopati y radiasi
Treatment Viral myelitis z z z
Antiviral treatment: Glucocorticoid Spasticity: baclofen (lioresal) 10 mg q6h, benzodiazepin and tizanidine.
