Myelitis

Dr. Kiking Ritarwan, MKT, SpS

 Myelitis

z Inflamation of the spinal cord

z I. Transverse Myelitis, II. Disseminata, III. Difussa
z Transverse myelitis (MYELOPATHY) is a syndrome
characterized by acute spinal cord dysfunction both
halves the cord in transverse section.
z 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 IS USUALLY BILATERAL AND TENDS TO

CAUSE MORE SEVERE WEAKNESS THAN
THE TYPICAL ATTACKS OF PARTIAL
MYELITIS.
z 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 1. Congenital – vascular malformation

z 2 Infectious – viral infection
2.
z 3. Autoimune- peri or post infection or vaccinial
myelitis.
z 4 Multiple sclerosis
4.
z 5. Neoplastic
z 6. Toxic- secondary to heroin injection
z 7. Vascular
z 8. Degenerative- irradiation
z 9. Idiopathic.
p
PATOLOGI

z JHTMC (John Hopkins Transverse Myelitis Center)

Æ kondisi inflamasi yyang
g berhubungan
g dengan
g
mekanisme immune
immune--mediated

z transversalisÆ perubahan inflamasi

Pasien myelitis transversalisÆ
pada medula spinalisnya

z Abnormalitas patologi ( bervariasi )

– infiltrasi lokal oleh limfosit dan monosit dalam segmen
medula spinalis dan daerah perivaskuler
– adanya y aktifitas yyangg bervariasi dari mikroglia
g dan astroglia
g
z Besar dan luasnya gambaran inflamasi Æ
f k etiologi
faktor i l iddan profile
fil perubahan
b h
myelopati :
– 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 Herpesvirus: HSV2, Varicella Zoster, HSV1,

E t i barr,
Epstein b C
Cytomegalo,
t l h
human h herpes6.
6
z Enterovirus: Poliovirus, Enterovirus 70,
E h i
Echovirus, C
Coxsackievirus.
ki i
z Arbovirus: west nile virus
z Oth Mumps,
Other: M HIV,
HIV Dengue.
D
Affinities virus in myelitis

z EnterovirusÆ anterior horn or nuclei of the

b i stem
brain t
z Herpes zosterÆ dorsal root ganglion
Clinical manifestation

z Acute paraplegic or Quadriplegic.

z Urinary retention.
z Sensory disturbances
Diagnostic prosedure

z 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 Multiple sclerosis
z Penyakit
y sistemik ((SLE,, Sjorgen
j g disease))
z Venous infarct
z Malformasi vaskuler (fistula AV, AVM, angioma
kavernosa)
z Fibrocartilagenous embolism
z Myelopati
y radiasi
Treatment Viral myelitis

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