1

Central Nervous
System Infection
(Infeksi
Susunan Saraf Pusat)

FOREWORD
Central Nervous System Infections is
a serious Illness
Late diagnosis and proper
Management leads to death or
serious disabilities
Early diagnosis and treatment is
important

CNS Infection may involve :

The leptomeninges and CSF

space (meningitis)
The gray and white matter of
the brain (encephalitis)
The spinal cord (myelitis)

Focus of bacterial infection of the brain

brain abcess or cerebritis in early
stage before a frank abcess is formed
Pus located betwen the duramater and
the arachnoid membrane subdural
empyema
Pus outside the dura is called an epidural
abcess.

Route Infection :

Open Wound around cephalic

Direct contiguous infection from otitis media,
sinus-sinus paranasal, skin infection around
cephalic and face.
Septisemia/ bakteriemia
Abses cerebri.

Retrograde infection along nerve.

Direct infection to CSF by non steril
lumbal punction.

Course :
Acute :

Subacute :
Purulent meningitis
Cerebral abcess
CNS listeriosis
Focal encephalitis
Herpes simplex encephalitis
Neuroborreliosis
Neurosyphillis
Tuberculous meningitis
Actinomycosis
Chronic
Nocardiosis
Tuberculous meningitis
Ricketsiosis
Neuroborreliosis
Neurobrucellosis
Neurosyphillis
Whipple encephalitis
Creutzfeldt-Jacob disease

1.

DIAGNOSIS OF
MENINGOENCEPHALITIS
Presence of symptoms of an
infection / fever

2. Presence of signs and symptoms of Central

Nervous System abnormalities:

Lowering of consciousness
Confusion
Convulsions
Neurological deficits

TWO MOST IMPORTANT

EXAMINATION IN DIAGNOSIS
1. Cerebrospinal fluid (CSF) examinations
Cell count, Glucose, Protein
Staining and Culture
Serological test
Polymerase Chain Reactions (PCR)
2. Neuro-Imaging :
CT-Scan
MRI

GENERAL LABORATORY
EXAMINATION
Blood Leukocyte and differential
count
Blood test for micro-organism :
culture / staining
serological
staining
PCR

10

WHAT IS THE NEXT

STEP
Cerebro spinal fluid examinations:
CSF pressure
Color / Turbidity
Qualitative protein test : Nonne / Pandy
Cell count / Differential cell count
Glucose content
Protein quantitative

11

CSF EXAMINATION
In Viral infections:
Cell count, Protein and Glucose content are not so
prominently altered.
In Bacterial and Fungal /Parasitic Meningitis:
Cell count, protein content are much more
pronouncedly alleviated, and glucose content lowered.

12

CSF ABNORMALITIES
Bacterial
Meningitis

Serous
Meningitis

Viral
Meningitis/
Encephalitis

Appearance

Purulent

Turbid/Xanth

Clear

Cell

> 10,000

< 500

< 100

Diff count

PMN >>

MN >>

MN >

Protein
Glucose

-0

13

STAINING OF
CSF/CULTURE
Best done if :

If possible not less than 10 cc CSF

Centrifuge at 2500 rpm for 5 minutes
Make staining and culture from sediment
For common bacteria : Gram stain
For Tuberculosis : Z N
For Cryptococcus : Indian Ink
Culture in suitable media
Tissue culture, serological testing , for Virus

14

Advantage:

POLYMERASE CHAIN
REACTION

Rapid diagnosis for certain diseases:

Tb Meningitis
Herpes Simplex encephalitis

Disadvantage:
Not readily available.
For certain specimen,
contamination is high

15

LABORATORY
EXAMINATION
Leucocyte and Differential count, pointing to acute or
chronic infections
Blood culture
Blood serological testing :
Treponema pallidum
Cysticercosis

Blood test for Malaria parasites

Chest X-ray

LUMBAR PUNCTURE
Contraindications
Infection in overlying skin
Relative
Coagulopathy
Thrombocytopenia

If delay is anticipated obtain blood cultures and GIVE

antibiotics
You have 2 hours after ATB given before sensitivity is
effected

17

CONTRA INDICATION TO
LUMBAR PUNCTURE
Signs of intracranial mass lesion/ papil edema
If an intracranial mass/hydrocephalus is suspected.
NEURO IMAGING is indicated, before CSF
examination.

18

PLAIN X-RAY
Indirectly to look for focus of Infections
Chest x-ray is a must : present of
pulmonary infections
Skull x-ray to look for focal infarction:
Mastioditis , Para nasal sinus infections ,
periodontal infection.
In suspected Cysticercosis , calcified cyst
in the muscle.

19

NEURO -IMAGING

CT-Scan should be done with contrast

In Brain Abscess - hyperintense ring
enhancement
Intracranial mass lesions due to
Toxoplasmosis, Fungal infections,
cysticercosis
In Tuberculous meningitis,
hyperintense visualization of the
subarachnoidal space will be seen

20

WHAT CAN BE SEEN IN

NEURO-IMAGING
IN CNS INFECTIONS
Presence of intra-cranial mass lesions
Brain infarction of due to vasculitis ,or
hemorrhage due to vascular damage
Hyper intensity of the CSF in Tb
Meningitis
Hydrocephalus due to CSF blockades
Brain edema like in Herpes Encephalitis

21

OTHER LESIONS
In congenital Toxoplasmosis,
multiple calcifications / hyperintense
lesion can be seen
In Herpes simplex, hypo intense
lesions due to edema can be seen in
the temporal and frontal areas.

22

MAGNETIC RESONANCE
IMAGING
Advantage:
More sensitive for certain lesions
Can detect abnormalities in more earlier
stage than CT-Scan
Disadvantage:
Good apparatus are more expensive
Takes more time for examinations, difficult in
delirious patients

23

ETIOLOGY OF CNS
INFECTIONS
In case of suspected CNS Infections, we
have to differentiate between:

Bacterial : Specific /non-specific

Parasites : Malaria / Toxoplasma
Fungal : Cryptococcus/Aspergillus's
Viral : Japanese Encephalitis HIV, Herpes
Prion Disease : TSE , CJD
Look for the possibility of MIXED infections

24

SPECIAL TO LOOK FOR

Tuberculosis
HIV / AIDS
AIDS related opportunistic infections:
Toxoplasma , Cryptococcus.

Cysticercosis in endemic areas

Malaria
Typhoid
New diseases ( Nipah E. , SARS )

25

CLINICAL SIGN AND

SYMPTOMS
Neurological Deficits
Sign of Increased Intracranial Pressure:
Papil edema
Severe headache
With or without fever

26

CLINICAL
PRESENTATION
Acute Meningo-Encephalitis
Intracranial tumor Like : Brain abscess,
tuberculoma,Toxoplasma etc.
First sign as Epilepsy : Cystecercosis
Degenerative disease Like : SSPE,TSE

27

CLINICAL
PRESENTATION OF
INFECTIVE
AGENTS
Meningitis: Bacterial
/ viral / fungal
Encephalitis: Viral
Brain abscess: Bacterial, fungal, parasitic
Sinus thrombosis: Bacterial

28

HISTORY TAKING
When does signs and symptoms begins
History of past illnesses ( HIV , Tuberculosis )
Economic status and occupation
Habit : i.v. drug use ?
Coming /traveling from Endemic areas ?
Any recent outbreak of human or animal desease?
( West Nile , Nipah )

29

PHYSICAL
EXAMINATION,
NEUROLOGICAL
Any sign of Infections ? Fever
,with headache, muscle
pain ?

Lowering of Consciousness
Alteration of Consciousness
Cranial nerve palsies
Neck stiffness/ meningeal signs
Limb paralysis / hemiplegia

30

PHYSICAL
EXAMINATION,
INTERNAL
Skin abnormalities , exanthema , bleedings.
Body temperature ? Fever ?
Vital signs ; Blood pressure ,pulse, respiration,
Respiratory abnormalities : Dyspnoeic ?
Abdomen : tenderness , stiffness . Liver /spleen
palpable ?

31

INFEKSI VIRAL

Tergantung pada :

Jumlah virus & virulensinya

Daya tahan tubuh yang rendah seperti :

Penyakit kronik
Gangguan imunologik
Reaksi alergi
Demam, obat-obatan
Radioterapi

Adanya kerusakan ginjal, paru, hepar, jantung &

susunan eritropoetik

VIRAL MENINGITIS

VIRAL MENIGITIS
85% secondary to
Echo Coxsackie
Entero-

Also consider HSV, and EBV

Neutrophils may predominate in the CSF in the first
24 hours
Consider starting ATBs until cultures come back (-)

INFEKSI VIRAL
34

MENINGITIS VIRAL
Bersifat benigne , gejalanya kadang sangat ringan
Pada keadaan berat memberikan gejala:
Sakit kepala
Kaku kuduk

LP : Pleiositosis limfositer . liquor jernih

Penyebab : paling sering dari kelompok
enterovirus :

V. poliomyelitis
V. coxsakie
V. ECHO (Entero Cytophatic Human Orphan)
Penetrasi melalui lintasan oral fecal / droplet spray

MENINGITIS
VIRAL

V. Coxsakie dikenal :
Kelompok A :
Menyebabkan meningitis
Eksantema bersifat rubeliform dengan herpangina di
tangan, kaki, mulut

Kelompok B
Menyebabkan meningitis disertai keletihan otot hingga
paralysis.
Rhinitis, laryngitis, bronchitis.
Eksantema tidak dijumpai.

35

MENINGITIS
VIRAL

36

V. ECHO :

Tersebar diseluruh dunia

Lebih sering pada anak
Anak sering rewel/ cengeng
Sering timbul gejala eksantema yang lebih
menonjol
Sakit kepala
Muntah, nyeri otot anggota gerak
24 jam timbul bercak bercak merah mulai
dari muka hingga ke badan.
Kaku kuduk & nyeri

EMPERIC ANTIVIRALS
Concern of herpes
Acyclovir 10mg/kg IV Q 8
hours

VIRAL
ENCEPHALITIS

VIRAL ENCEPHALITIS
Infection of brain parenchyma
Presents of neurological
abnormalities distinguish it from
meningitis

EPIDEMIOLOGY
Incidence is 1/10 of bacterial meningitis
HSV-1, zoster, EBV,CMV, rabies, arbo
Arbo
LAC (La Crosse)-diagnosed most frequently
SEE(St Louis)-20% mortality in elderly
WEE(Western)- causes seizures in 90% of infected
infants, permanent neuro deficits in 50%
EEE(Eastern)- most devastating, mortality 70%
WNV(West Nile)

ENSEPHALITIS VIRAL

Virus DNA:

41

ETIOLOGI

Poxviridae
: Poxvirus
Herpetoviridae : Virus Herpes simpleks, Varicella Zoster,
dan Virus sitomegalik

Virus RNA
Paramiksoviridae
: Virus parotitis, virus morbili
(rubeola).
Picornaviridae : Enterovirus, Virus poliomielitis,
Echovirus,
Coxsackie A, Coxsackie B.
Rhabdoviridae : Virus rabies.
Togaviridae
: Virus ensevalitis alpha, Flavivirus
ensefalitis
Jepang B, Virus demam
kuning, Virus rubi.
Bunyaviridae
: Virus ensefalitis california.
Arenaviridae
: Khoromeningitis Limfositaria.
Retroviridae
: Virus HIV

PATHOPHYSIOLOGY
Portals of entry
Arbo-transmitted by mosquitoes, ticks
Rabies-bite by infected animal

Hematogenous dissemination v. travel backwards on

axons (HSV,HZV,rabies)
Dysfunction & damage caused by disruption of neural
cell function & inflammation

PATHOPHYSIOLOGY
CONT.
Gray matter predominately affected
Cognitive/psychiatric signs, lethargy,
seizures
White matter affected in post-infectious
encephalomyelitis

CLINICAL FEATURES
New psych symptoms
Cognitive deficit (aphasia, amnesia,
confusion)
Seizure
Movement d/o

DIAGNOSIS
MRI-more sensitive than CT
CT Scan
EEG
LP-findings consistent with aseptic
meningitis

DIFFERENTIAL
Exclude the killers
Bacterial meningitis & SAH

More meningeal symptoms

Lyme, TB, fungal, bacterial, viral, neoplastic

More parenchymal symptoms

Abscess, bacterial endocarditis, post-infectious
encephalomyelitis, toxic or metabolic encephalopathy

TREATMENT
HSV: acyclovir 10mg/kg IV
CMV: ganciclovir
Rabies/EEE/HSVdevastating & usually
fatal or residual deficits

BACTERIAL
MENINGITIS

EPIDEMIOLOGY
400 per 100,000 in neonates
1-2 per 100,000 in adults
S pneumoniae & N meningitidis m/c
HIB vaccine has been very effective

Mortality
5% in children beyond infancy
25% in neonates and in adults

PATHOPHYSIOLOGY
S. pneumonia and N. meningitidis (and H.
influenzae) are encapsulated which
provides them with increased ability to
invade BBB
Upper airway bloodstream
subarachnoid space subcapsular
constituents trigger inflammation fever,
meningimus, change in MS
brain/meningeal edema decreased CSF
drainage hydrocephalus increased
ICP ICP>CPP

51

CLINICAL FEATURES
25% of adult cases classic
Rapid development of

Fever
Headache
Stiff neck
Photophobia

Nonspecific signs/symptoms in very young/old

25% will develop seizures

MENINGITIS
BAKTERIAL
AKUT

Pada neonatus , meningitis purulent

menunjukkan gejala :

panas tinggi yang akut

dyspnoe
tidak mau menetek
icterus, kesadaran menurun
kejang & koma.

Sering disebabkan oleh :

E Coli
Streptokokus
Stafilokokus
Pneumokokus

53

MENINGITIS
BAKTERIAL AKUT

54

Pada bayi dan anak-anak yang lebih besar

menunjukkan gejala:

tidak mau makan

irritable
confuse & letargy
kejang & koma.

Sering disebabkan oleh :

H. Infulenza
Meningokokus
Pneumokokus
E Coli
Streptokokus

MENINGITIS
BAKTERIAL AKUT

Pada orang dewasa sering disebabkan oleh :

Pneumokokus
Meningokokus
Streptokokus
Stafilokokus
H. Infulenza

55

CLINICAL FEATURES
History
Living conditions
College dorm/barracksN meningitidis

Trauma
Recent neurosurgeryStaph/gram(-) rod

Immunocompetence
Immunization hx
NoneHiB

Antibiotic use

CLINICAL FEATURES
Physical Exam
Brudzinski
Passive neck flex hips & knees flex

Kernig
Flex hip, ext knee hamstrings contract

Skin
Purpura
Petechiae/splinter hem, pustular
lesionsmicroemboli

Funduscopy
Neurology Examination

DIAGNOSIS
Parenchymal
CT is the imaging of choice
Brain abscess, encephalitis, toxoplasmosis

Meningeal
Lumbar puncture
Neoplasm, CNS vasculitis, SAH

DIAGNOSIS
Parameter
(normal)

Bacteri Viral
al

Neoplas Fungal
tic

OP (<170 mm
CSF)

>300mm

200mm

200

300mm

WBC
(<5mononuclea
r)

>1000

<1000

<500

<500

%PMNs (0)

>80%

1-50%

1-50%

1-50%

Glucose
(>40mg/dL)

<40

>40

<40

<40

Protein
(<50mg/dL)

>200

<200

>200

>200

Gram stain (-)

Cytology (-)

60

TREATMENT
First priority
Antibiotics
Second priority in some cases
Anti-inflammatories
Third priority
Counter the adverse effects of increased ICP
& vasculopathy

EMPERIC ANTIBIOTICS
Age/Special

Gram Stain

Drug

18-50y/o

Negative

Ceftriaxone 2g IV +
vanco 1g IV or rifampin

>50 y/o

Negative

Ceftriaxone +
Ampicillin + vanco or
rifampin

Recent
penetrating head
injury/
surgery/shunt

Negative

Vanco 25mg/kg then

19mg/kg using Matzke
nonogram +
ceftazidime

immunocompromis
ed

Negative
-------------
GPC
-----------------
GNC
-----------------

Vanco+ amp+
ceftazidime
Ceftriaxone + vanco
Pen G
Amp + gent
Cetazidime +

COMPLICATIONS
Seizures
Hyponatremia
SIADH
CVA
Coagulopathies
Cognitive deficits, epilepsy, hydrocephalus, hearing
loss affect 25% of survivors

MENINGITIS TUBERKULOSA
Berupa meningitis serosa akibat reaksi
peradangan yg disebabkan oleh
kuman tuberkulosa Terutama pada
anak
Penjalaran berasal dari :
Paru paru secara hematogen
Infeksi TB di mastoid
Spondilitis TB
64

MENINGITIS TUBERKULOSA

Pemeriksaan Fisik:
Tanda-tanda rangsangan meningeal berupa kaku
kuduk, tanda Laseque dan Kernig
Kelumpuhan saraf otak sering dijumpai

Pemeriksaan Penunjang :
LCS :
Pelikel (+)/Cobweb Appearance (+)
Peliositosis 50 500/mm3, dominan sel mononuklear,
protein meningkat 100-200 mg%, glukosa menurun < 5060%, bakteriologis Ziehl Nielsen (+), kultur BTA (+)

IgG anti TB atau PCR

Thorax foto
CT Scan Kepala atau MRI
65

MENINGITIS TUBERKULOSA

Diagnosa Banding
Meningoencephalitis karena Virus
Meningitis bakterial yang pengobatannya tidak
sempurna.
Meningitis oleh karena infeksi jamur/parasit
(Cryptococcus neoformans atau toxoplasma
gondii), sarcoid meningitis
Tekanan selaput yang difus oleh sel ganas,
termasuk karsinoma, limfoma, leukemia, glioma,
melanoma dan medulablastoma.

66

MENINGITIS TUBERKULOSA

Tatalaksana :
Umum
Terapi kausal : kombinasi obat anti
tuberkulosa (OAT)

INH
Pyrazinamida
Rifampisin
etambutol

67

MENINGITIS TUBERKULOSA

Komplikasi :

Hidrosefalus
Kelumpuhan saraf kranial
Iskemi dan infark pada otak dan mielum
Epilepsi
SIADH
Retardasi mental
Atrofi nervus optikus

Prognosis
Sembuh lambat dan umumnya
meninggalkan sekuele neurologis

68

Brain Abscess

Brain Abscess
Focal pyogenic infection
Pus-filled cavity ringed by
granulation tissue & outer fibrous
capsule surrounded by edematous
brain tissue

Epidemiology
Paranasal sinus focus
10-30 y/o

Otic
Bimodal: <20 y/o & >40 y/o

Pathophysiology
Hematogenous spread
1/3 of cases

Contiguous (middle ear, sinus, teeth)

1/3 of cases
Otogenic (Bacteroides)temporal
lobe/cerebellum
Sinogenic & odontogenic(anaerobic &
microaerophilic streptococci)frontal
lobe

Clinical Features
Classic triad
Headache, fever, focal deficit <1/3 of
cases
Toxic appearance is rare
Seizures, vomiting, confusion,
obtundation possible
Frontal lobe-hemiparesis
Temporal lobe- homonymous superior
quadrant visual field deficit or aphasia
Cerebellum-limb incoordination or
nystagmus

74

Diagnosis
CT with contrast
LP contraindicated
Biopsy or aspiration for
confirmation

Treatment
Presumed
Source

Primary
Empiric Tx

Alternative Tx

Otogenic

Cefotaxime 2g IV q8h

Bactrim 5mg/kg IV q6h

+
Flagyl 1giv then 500mg
q6 or chloramphenicol

Sinogenic or
odontogenic

Pen 24 million units/d IV

divided q4h
+
Flagyl 1g IV then 500mg
q6h

Pen (same dose)

+
Chloramphenicol
100mg/kg/d divided q6h

Penetrating
trauma or
neurosurgery

Nafcillin 2g IV q4h +
Ceftazidime 2g IV q8h

Vanco 15mg/kg (max

1g)IV q6h +
Ceftazidime 2g IV

Hematogenous

Pen 24 million units/d

divided q4h +
Flagyl 1g then 500mg
q6h

Pen (same dose) +

Chloramphenicol
100mg/kg/d divided q6h

No obvious
source

Cefotaxime 2g IV q6h + No recommendations

Flagyl 1g IV then 500mg

77

INFEKSI
SPIROKHETAL
Disebabkan oleh kuman :
Leptospira
ikterohemoragika
Treponema

78

INFEKSI SPIROKHETAL

LEPTOSPIROSIS
Penularan leptospirosis melalui air minum
yang terkontaminasi dengan kencing host
leptospira seperti tikus , kelinci, marmot.
Penularan antar manusia tidak pernah
terjadi karena leptospira tidak dapat
hidup dalam urine manusia yang
keasamannya rendah.

79

INFEKSI SPIROKHETAL

LEPTOSPIROSIS
Kuman masuk kedalam traktus digestivus
menyebar melalui pembuluh darah ke
organ organ tubuh terutama ke hati dan
ginjal kemudian menimbulkan reaksi
peradangan, oedema akhirnya terjadi
hepatic failure dengan ikterus obstruktif,
renal failure.

80

INFEKSI SPIROKHETAL

LEPTOSPIROSIS
Gejala lain yang menyertainya : myalgia,
konjunctivitis perikorneal, uveitis,
hemorhagi, meningitis leptospirosis
(paling sering 50%), hemorhagi serebri.
Meningitis leptospirosis menyerupai
meningitis serosa / meningitis aseptic.

81

INFEKSI SPIROKHETAL

SIFILIS

Disebabkan oleh kuman Treponema

pallidum.
Kuman ini tidak tahan terhadap panas,
mudah terbunuh oleh sabun, antiseptika,
pengeringan. Hanya bisa bertahan hidup
pada keadaan dingin.
Penularan melalui kontak seksual.

82

INFEKSI SPIROKHETAL

SIFILIS

Gambaran penyakit :
Menyerupai organic brain syndrome.
Gejala prodromal berupa sakit kepala,
insomnia, cepat lupa, daya konsentrasi
menurun, badan letih. Pada tahap lanjut
timbul dementia dan perubahan watak
yang menyerupai psikosis.

83

INFEKSI FUNGAL
Sering disebabkan oleh kriptokokus,
nokardia, mukomikosis, koksidiomikosis,
aktinomikosis, aspergillus.
Penyebaran secara hematogen sering
berasal dari paru paru.
Meningitis oleh infeksi fungal ini
menyerupai meningitis serosa.

84

INFEKSI PROTOZOAL
Disebabkan oleh :
Tripanosomiasis (tripanozoma gambiense)
Malaria (Plasmodium Falciparum)
Toksoplasmosis & amubiasis

INFEKSI PROTOZOAL

Gejala Klinis :

85

TOXOPLASMOSIS

80 90 % pasien tidak
menimbulkan gejala
jika ada tersering limpadenopati
Hidrosephalus
Kalsifikasi serebral
Khorioretinitis
ada binatang peliharaan kucing

INFEKSI PROTOZOAL

86

TOXOPLASMOSIS
Liquor :
kronik N
Akut protein & limphosit meningkat
EEG gelombang delta diselingi spike.
Pada keadaan kronis EEG normal
CT Scan :
lesi multiple yang menyerap kontras
bentruk bisa cincin atau noduler
tumor di white matter
dgn edema otak diffus

87

INFEKSI METAZOAL
Disebabkan oleh :
Nematoda : trikinela spiralis
Trematoda : Skistosoma & paragonimus
Sestoda :

Tenia solium sistiserkosis

Ekinokokus granularis
hidatidosis
Mutiseps-mutiseps

INFEKSI METAZOAL

88

SCHISTOSOMIASIS
Terbanyak di Cina, Philipina, Indonesia, Laos,
Thailand
CT Scan : seperti granuloma lainnya
EEG : gelombang lambat abnormal, fokal
epilepsy
LP : sel meningkat lymphositosis, bebrapa
eosinofil. Protein meningkat
Gejala klinik : kejang umum & epilepsy Jakson.

INFEKSI METAZOAL

89

CEREBRAL
PARAGONIMIASIS
Biasanya di lobus oksipitalis & parietal
Bisa kena n II
LP : protein meningkat, pleiocytosis
(eosinofil (+))
CT Scan :
biasanya selain ada kalsifikasi terdapat
banyak vascularisasi

INFEKSI METAZOAL

90

CYSTICERCOSIS
Sering kena otak, mata (visual field terganggu) , otot
(pseudohipertropi)
Kejang , hidrosephalus
Gejala klinik : SOP
CT Scan : single/multiple area hipodens didalam
jaringan otak
Tidak dikelilingi cincin dan edema
LP : tekanan meningkat, pleiositosis, Ig G meningkat,
glukosa menurun

91

MIELITIS
TRANSVERSA
Yaitu radang medulla spinalis yang mengenai
segmen medulla spinalis (substansia alba & grisea).
Etiologi :
Pasca infeksi atau parainfeksi : infeksi virus, rubeola,
varisella, variola, jarang pada rubella, mumps,
influenza.
Pasca vaksinasi : anti rabies, varisella, pertusis, polio,
tetanus.
Nekrotik atau degeneratif
AIDS (Aquired Immuno Deficiency Syndrom)
Dasar terjadinya mielitis oleh karena reaksi alergi

92

MIELITIS TRANSVERSA

GAMBARAN KLINIS :
Pasca infeksi / pasca vaksinasi mulai timbul
deficit neurology setelah 5 10 hari
Perjalanan penyakit akut
50% timbul dalam waktu 12 jam
75% timbul dalam waktu 24 jam

Mula mula berupa demam, malaise, mialgia.

Deficit neurologik berupa
Kelemahan ekstremitas
Gangguan sensibilitas
Gangguan genitourinaria & defekasi

Segmen medulla spinalis yang sering terkena

antara segmen thoracal 2 thorakal 6.

93

MIELITIS TRANSVERSA

GEJALA NEUROLOGIK
AWAL :

Parestesia anggota gerak bawah dan tubuh dengan

pola segmental
Kadang nyeri punggung yang menjalar sepanjang
batas atas lesi medulla spinalis.
Pada keadaan akut timbul fase syok spinal dengan
gejala paralysis flaksid ke 2 tungkai, retensio urine &
alvi, setelah 3 6 mg baru muncul paralysis spastic.
Neuritis optika Devic disease.

94

MIELITIS TRANSVERSA

LABORATORIUM :
Liquor :
Hambatan aliran liquor
Pleiositosis moderat 20 200 sel/mm3 . limfosit lebih
banyak.
Protein sedikit meningkat 50 120 mg/dl.
Kadar glukosa normal.

95

TERIMA
KASIH