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

MYELITIS
Gray matter Poliomyelitis.
White matter . 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 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 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 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)

kondisi inflamasi yang berhubungan dengan
mekanisme 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 aktifitas yang bervariasi dari mikroglia dan astroglia

 Besar

dan luasnya gambaran inflamasi

faktor etiologi dan profile perubahan
myelopati :

Myelitis post infeksius perubahan white matter,

demielinasi, gangguan aksonal
myelitis transversalis gambaran yang
melibatkan keduanya secara bersamaan baik
white maupun grey 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 DIAGNOSTIK

Dikutip dari : Transverse Myelitis Consortium Working Group. Proposed

diagnostic criteria and nosology of acute transverse myelitis. Neurology

DIAGNOSIS BANDING :

Multiple sclerosis
Penyakit sistemik (SLE, Sjorgen disease)
Venous infarct
Malformasi vaskuler (fistula AV, AVM, angioma
kavernosa)
Fibrocartilagenous embolism
Myelopati radiasi

Treatment Viral myelitis

Antiviral

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