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 karakteristik klinis i di disfungsi f i neurologis l i pada d saraf f motorik, sensorik dan otonom dan traktus saraf di medula spinalis

MYELITIS
Gray matter Poliomyelitis. White matter . Leukomyelitis. Leukomyelitis The whole crossectional areTranversemyelitis. Lesions are multiple and wide spreadOver a long vertical extent.. DiffuseOr Disseminated. Combined meninges and spinal cordMeningomyelitis. 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

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 li infection, f ti including poliovirus, echovirus and coxsackieviruses.

Etiologie Transverse myelitis

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

JHTMC (John Hopkins Transverse Myelitis Center) kondisi inflamasi y yang g berhubungan g dengan g mekanisme immune immune-mediated Pasien myelitis transversalis perubahan inflamasi pada medula spinalisnya 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

Besar dan luasnya gambaran inflamasi f k etiologi faktor i l id dan profile fil perubahan b h myelopati :

Myelitis post infeksius perubahan white matter, demielinasi, gangguan aksonal myelitis y transversalis g gambaran y yang g melibatkan keduanya secara bersamaan baik white maupun grey matter

Viral causes of acute myelitis

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

Enterovirus anterior horn or nuclei of the b i stem brain t Herpes zoster dorsal root ganglion

Clinical manifestation

Acute paraplegic or Quadriplegic. Urinary retention. Sensory disturbances

Diagnostic prosedure

CSF examination: - mild ild t to moderate d t l lymphocytic h ti pleocytosis l t i (10 (10-1000 1000 cell/mm3), elevated protein (100-500 mg/dl), and normal or mildly y 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 :

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

Antiviral treatment: Glucocorticoid Spasticity: baclofen (lioresal) 10 mg q6h, benzodiazepin and tizanidine.