Professional Documents
Culture Documents
Trauma Medulla Spinalis
Trauma Medulla Spinalis
S
Bagian Ilmu Penyakit Saraf
Fakultas Kedokteran Universitas YARSI
Pendahuluan
Trauma medulla spinalis/spinal cord injury
(SCI) defisit neurologis & hendaya
permanen
Tujuan menegakkan diagnosis & memulai
terapi secepatnya mencegah defisit lanjut
(primer & sekunder)
Epidemiologi
AS, 2006
Insidens + 50 / 1 jt populasi, 14.000 ps/th (AS,
2006)
Pria : wanita = 2,5 - 3 : 1
80% pria dg SCI (spinal cord injury) berusia 18-25
th
Australia, 2006
Insidens 12 / 1 jt populasi / th
Indonesia ??
Perkiraan Persentase
Dari Keseluruhan SCI
Kecelakaan bermotor
Mobil
Motor
Sepeda
Jatuh
Kekerasan individual
Luka tembak
Kekerasan lain
Olahraga dan rekreasi
Menyelam (2/3 kasus dalam kategori ini)
Football dan rugby
Hoki
Senam
Gulat
50
15-20
15-20
10-15
Sekunder
Kaskade biokimia & proses selular kerusakan /
kematian sel
Perubahan vaskular, perubahan kadar ion, akumulasi
neurotransmiter, produksi radikal bebas & lipid
peroksidase, efek opioid endogen, edema, inflamasi,
ATP
Critical Care and Resuscitation 2006;8:56-63
Neurosurgery 1999;44:1027-40
Complete
Grade B
Incomplete
Grade C
Incomplete
Grade D
Incomplete
Grade E
Normal
Terapi
Methylprednisolone / MP (corticosteroid)
Tirilazad mesylate (corticosteroid)
Naloxone
GM-1 ganglioside
Methylprednisolone
Efek neuroprotektif MPSS (MP-sodium
succinate)
Menghambat lipid peroksidase
Menghambat influks kalsium
Menghambat iskemia
Efek anti inflamasi
Methylprednisolone
MP (30 mg/kg IV loading dose followed by 5.4
mg/kg/h for the next 23 h NASCIS 2 regimen) may
be considered in pts w/ blunt ASCI presenting less
than 3 h after injury after considering the potential
risks & benefits to the pt
MP (30 mg/kg IV loading dose followed by 5.4
mg/kg/h for the next 47 h NASCIS 3 regimen) may
be considered in pts w/ blunt ASCI presenting
between 3 and 8 h after injury after considering the
potential risks & benefits to the pt
Steroids should not be administered to pts w/ blunt
ASCI presenting greater than 8 h after injury
Methylprednisolone
NASCIS II (1990, Class II)
Prospective, randomized, double-blind multi-center trial in 487 pts w/ ASCI
3 arms :
MPSS 30 mg/kg bolus given within 15 min, followed by 5.4 mg/kg/h infusion for 23
h
Naloxone 5.4 mg/kg bolus given within 15 min, followed by 4.5 mg/kg/h infusion
for 23 h
Placebo infusion
All primary outcome measures, including neurologic outcome & mortality, didnt
differ between the 3 groups
Post hoc subgroup analysis of fewer than 50% of those enrolled identified improved
neurologic fx in pts treated w/ MPSS within 8 h of injury.
Pts who received MPSS more than 8 h after injury demonstrated worse neurologic
fx than did the placebo group
Increased wound infection, GI bleeding, & pulmonary embolus in pts who received
MPSS although these differences were not statistically significant
Methylprednisolone
Methylprednisolone
Merola et al., 2002 perubahan jaringan scr
mikroskopik thd pemberian MP dosis tinggi
dilanjutkan 23 jam berikutnya pd tikus
Edema & struktur yang berkaitan dg lokasi
injuri dipertahankan
Tdk mengubah perkembangan proses nekrosis /
response sel astrosit pada lokasi injuri MS
Prognosis
Ps hidup > 18 bl angka harapan hidup 70%
(tetraplegia) & 84% (paraplegia)
5 tahun setelah SCI, mortalitas :
Septicemia 40x
Pneumonia 13x
Emboli paru 8x
Penyakit jantung 3x
Gg. berkemih 9x
Bunuh diri 2x
Prognosis
SCI segmen servikal, torakal, & torakolumbal
prognosis perbaikan neurologis incomplete >
complete
Complete (prognosis perbaikan klinis dlm 1 th)
servikal > torakal > torakolumbal (T11-T12, L1-L2)
Incomplete (prognosis perbaikan klinis dlm 1 th)
servikal = torakal > torakolumbal
Ps dg komplit SCI < 5% perbaikan
Jk komplit SCI menetap dlm 72 jam perbaikan 0
17
18
19
20
21
22