Myelitis 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
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
MYELITIS MYELITIS
Gray matter Poliomyelitis.
White matter Leukomyelitis White matter . Leukomyelitis.
The whole crossectional areTranversemyelitis.
Lesions are multiple and wide spreadOver a long vertical extent..
DiffuseOr Disseminated. DiffuseOr Disseminated.
Combined meninges and spinal cordMeningomyelitis.
Combined meninges and root--- meningpradiculitis.
Inflammatory disease limited to the spinal dura. Pachymeningitis. y p 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
IS USUALLY BILATERAL AND TENDS TO
CAUSE MORE SEVERE WEAKNESS THAN CAUSE 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 ti associated with many viral infection,
including poliovirus, echovirus and
coxsackieviruses.
Etiologie Transverse myelitis
1. Congenital vascular malformation
2 Infectious viral infection 2. Infectious viral infection
3. Autoimune- peri or post infection or vaccinial
myelitis.
4 Multiple sclerosis 4. Multiple sclerosis
5. Neoplastic
6. Toxic- secondary to heroin injection
7. Vascular
8. Degenerative- irradiation
9. 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 g y g g g
mekanisme mekanisme immune immune--mediated mediated
Pasien myelitis transversalis Pasien myelitis transversalisperubahan inflamasi perubahan inflamasi Pasien myelitis transversalis Pasien myelitis transversalisperubahan inflamasi perubahan inflamasi
pada medula spinalisnya pada 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 astroglia adanya aktifitas yang bervariasi dari mikroglia dan astroglia y y g g g y y g g g
Besar dan luasnya gambaran inflamasi Besar dan luasnya gambaran inflamasi
f k i l i d fil b h f k i l i d fil b h faktor etiologi dan profile perubahan faktor etiologi dan profile perubahan
myelopati : myelopati :
Myelitis post infeksius Myelitis post infeksius perubahan perubahan white matter white matter Myelitis post infeksius Myelitis post infeksius perubahan perubahan white matter white matter, ,
demielinasi, gangguan aksonal demielinasi, gangguan aksonal
myelitis transversalis myelitis transversalis gambaran yang gambaran yang yy g y g g y g
melibatkan keduanya secara bersamaan baik melibatkan keduanya secara bersamaan baik
white white maupun maupun grey matter grey matter
Viral causes of acute myelitis
Herpesvirus: HSV2, Varicella Zoster, HSV1,
E t i b C t l h h 6 Epstein barr, Cytomegalo, human herpes6.
Enterovirus: Poliovirus, Enterovirus 70,
E h i C ki i Echovirus, Coxsackievirus.
Arbovirus: west nile virus
Oth M HIV D Other: Mumps, HIV, Dengue.
Affinities virus in myelitis
Enterovirusanterior horn or nuclei of the
b i t brain stem
Herpes zosterdorsal 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 DIAGNOSTIK 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 : DIAGNOSIS BANDING :
Multiple sclerosis Multiple sclerosis
Penyakit sistemik (SLE, Sjorgen disease) Penyakit sistemik (SLE, Sjorgen disease) y ( , j g ) y ( , j g )
Venous infarct Venous infarct
Malformasi vaskuler (fistula AV, AVM, angioma Malformasi vaskuler (fistula AV, AVM, angioma
kavernosa) kavernosa) kavernosa) kavernosa)
Fibrocartilagenous embolism Fibrocartilagenous embolism
Myelopati radiasi Myelopati radiasi yy
Treatment Viral myelitis
Antiviral treatment:
Glucocorticoid
Spasticity: baclofen (lioresal) 10 mg q6h,
benzodiazepin and tizanidine.