Download - GANGGUAN MEDULA SPINALIS
![Page 1: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/1.jpg)
GANGGUAN MEDULA SPINALIS
Oleh :Dr. Syarif Indra, SpS
![Page 2: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/2.jpg)
I. Anatomi fisiologi
• Medula Spinalis terletak didalam foramen vertebra
• Gambar :– Sistem saraf–Vaskularisasi
![Page 3: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/3.jpg)
![Page 4: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/4.jpg)
![Page 5: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/5.jpg)
![Page 6: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/6.jpg)
![Page 7: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/7.jpg)
II. Klasifikasi gangguan medula spinalis
1. Direk Primer
Medula Spinalis Selaput Vaskularisasi
2. Indirek Sekunder mempengaruhi lesi MS ok
gangguan vertebra Gambar : segmen vertebra AP/Lateral
![Page 8: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/8.jpg)
![Page 9: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/9.jpg)
III. Jenis Gangguan
1. Gangguan Kongenital2. Trauma3. Neoplasma4. Inflamasi
![Page 10: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/10.jpg)
Jenis Lesi
1. Hemilesi : satu sisi MS2. Transversa : satu segmen MS3. Diseminata : Beberapa segmen4. Difusa : banyak tempat dari 1 segmen
Gambar : - Distribusi lesi MS - Dermatoma
![Page 11: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/11.jpg)
![Page 12: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/12.jpg)
HemilesiEtiologi :
Trauma tajamInflamasi vertebraTumor sesisi
Gejala :a.Ipsilateral :
oKelumpuhan LMN setinggi lesi gangguan radiks anterior
![Page 13: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/13.jpg)
![Page 14: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/14.jpg)
oKelumpuhan UMN dibawah lesi gangguan tr. Kortikospinalis
oAnestesi/parestesi setinggi dermatom lesi gangguan radiks posterior
oGangguan prosprioseptif ( vibrasi, posisi) gangguan funikulus dorsalis
![Page 15: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/15.jpg)
b. Kontralateral o Suhu dan nyeri terganggu dibawah
lesi gangguan traktus spinotalamikus lateral
o Rasa raba terganggu setinggi lesi gangguan traktus spinotalamikus anterior
![Page 16: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/16.jpg)
Lesi Transversa
Etiologi: Infeksi mielitis, spondilitisTrauma Tumor
Gejala a.Gangguan motorik (UMN) :
Paraplegi/paresis : dibawah thoracal I Tetraplegi/paresis : diatas Cervical VIII
![Page 17: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/17.jpg)
![Page 18: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/18.jpg)
b. Gangguan sensibilitas : –Sesuai lesi dan berbatas tegas
c. Gangguan otonom :–Miksi–Defekasi–Sekresi keringat
![Page 19: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/19.jpg)
Lesi Diseminata
• Etiologi :– Infeksi virus– Degenerasi
• Gejala :– Gangguan motorik : kelumpuhan asimetris,
beberapa dermatom MS– Gangguan sensorik : asimetris– Gangguan otonom ±
![Page 20: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/20.jpg)
Lesi Difusa
• Etiologi :– Virus– Toksik/kimia
• Gejala– Gangguan motorik dan sensorik > 1 segmen
![Page 21: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/21.jpg)
Mielitis Transversa
• Disfungsi akut Medula Spinalis
• Insiden 1-4 : 10.000
• Semua usia : - 10 – 19 th >>
- 30 -39 th >
• Etiologi : - viral (Herpes, HIV)
- bakteri (TB)
- jamur (mycoplasma)
![Page 22: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/22.jpg)
• Gejala : - prodormal +/-- kelumpuhan (25%)- hipestesi/parastesi (25%)- nyeri pinggang (25%)- nyeri radik (22%)- gangguan otonom (3%)
![Page 23: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/23.jpg)
• Berdasarkan waktu : Shock phase- akut < 2 minggu- subakut 2-6 minggu- kronik > 6 minggu
• Diagnosis - Klinis - LP Sel ↑ , protein ↑
![Page 24: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/24.jpg)
• Penatalaksanaan :IstirahatAntibiotik ( causa dan preventif)KortikosteroidRehalibitasiResosialisasi Atasi komplikasi
• PrognosisTergantung etio, lesi dan komplikasi
![Page 25: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/25.jpg)
Spondilitis Tuberkulosis
• Etio kuman TBC• Semua umur 15-35 th >>• Sekunder + 80% ada fokus primer
(hematogen)• Lesi : kolumna vertebralis Thorakal >>• Mengenai 1 corpus / multipel
• Proses : infeksi korpus destruksi kolaps kolumna vetebre Gibus (Pott disease)
![Page 26: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/26.jpg)
Gejala klinis
1. Gejala TB primer : Paru, kelenjar, dll2. Gejala lokal : deformitas, nyeri tekan dan
nyeri ketok vetebre3. Iritasi radik nyeri radikuler4. Gejala meduler
– Lesi tr piramidalis (motorik)– Lesi transversa inkomplit (sensorik, motorik)– Gangguan sensorik jarang
![Page 27: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/27.jpg)
• Komplikasi meduler1. Kompresi Medula Spinalis2. Edema medula Spinalis3. Herniasi diskus4. Pakimeningitis
![Page 28: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/28.jpg)
• Ro foto - Destruksi Korpus - Penyempitan diskus - Gibus - Abses
• Lumbal pungsi Kuman pd dural, protein ↑,
sel N / ↑
![Page 29: GANGGUAN MEDULA SPINALIS](https://reader033.vdocuments.net/reader033/viewer/2022061411/56814548550346895db217e2/html5/thumbnails/29.jpg)
Terapi
1. Tanpa gejala meduler
– Imobilisasi
– Medikamentosa
2. Dengan gejala meduler
– Bedah orthopedi