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 – karakteristik klinis disfungsi neurologis pada saraf

motorik, sensorik dan otonom dan traktus saraf di medula spinalis

MYELITISGray 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 DISEASEOF THE SPINAL CORD … SEE TRANSPARANTS

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.

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.

PATOLOGI

JHTMC (John Hopkins Transverse Myelitis Center) JHTMC (John Hopkins Transverse Myelitis Center) kondisi inflamasi yang berhubungan dengan kondisi inflamasi yang berhubungan dengan mekanisme mekanisme immune-mediatedimmune-mediated

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

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 astroglia

Besar dan luasnya gambaran inflamasi Besar dan luasnya gambaran inflamasi faktor etiologi dan profile perubahan faktor etiologi dan profile perubahan myelopati :myelopati :– Myelitis post infeksius Myelitis post infeksius perubahan perubahan white matter white matter, ,

demielinasi, gangguan aksonaldemielinasi, gangguan aksonal– myelitis transversalis myelitis transversalis gambaran yang gambaran yang

melibatkan 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, Epstein barr, Cytomegalo, human herpes6.

Enterovirus: Poliovirus, Enterovirus 70, Echovirus, Coxsackievirus.

Arbovirus: west nile virus Other: Mumps, HIV, Dengue.

Affinities virus in myelitis

Enterovirus anterior horn or nuclei of the brain stem

Herpes zoster dorsal root ganglion

Clinical manifestation

Acute paraplegic or Quadriplegic. Urinary retention. Sensory disturbances

Diagnostic prosedure

CSF examination: - mild to moderate lymphocytic pleocytosis (10-1000

cell/mm3), elevated protein (100-500 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.

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 sclerosis Penyakit sistemik (SLE, Sjorgen disease)Penyakit sistemik (SLE, Sjorgen disease) Venous infarctVenous infarct Malformasi vaskuler (fistula AV, AVM, angioma Malformasi vaskuler (fistula AV, AVM, angioma

kavernosa)kavernosa) Fibrocartilagenous embolismFibrocartilagenous embolism Myelopati radiasiMyelopati radiasi

Treatment Viral myelitis

Antiviral treatment: Glucocorticoid Spasticity: baclofen (lioresal) 10 mg q6h,

benzodiazepin and tizanidine.