DISEASE OF MEDULA SPINALISDr. Nurdjaman Nurimaba, Sp.SKNeurological Department, Faculty of Medicine / Hasan Sadikin General Hospital

PREFACEMedula spinalis contain : - Cervical : 8 segments - Thoracal : 12 segments - Lumbal : 5 segments - Sacral : 5 segments Medula spinalis disturbance : - Tetraparese / plegi - Paraparese / plegi : inferior / sup - Triparese / plegi

Medula spinalis function : -Motoric - Sensoric -Reflex - Autonom : 1. Simpatic (T1 & L2) 2. Parasimpatic (S2-S4)

Treatment of medula spinalis disturbance : -Plegi / parese : Fisiotherapy -Sensoric & autonom : movement of position, every 2 hours and hygiene.

Vascularisation of medula spinalis : 1. A. spinalis posterior ( sin & dex) 2. A. spinalis anterior (only one)

Disease of medula spinalis : 1. Tumor 2.Vascular 3. Inflammation 4.Trauma 5. Degeneration disease 6.Congenital disease

NeoplasmExtradural tumor : -50 % - Metastatic : blood, lung, liver, prostat, thyroid. -Caused compressionIntradural tumor : a. Intramed tumor : 29 % from glia cells, ependym.

b. Extramed tumor : - 70 % - Meningioma (female) - Neurolemoma (male)

Differentiation of tumor

Extramed

Intramed

Pain

Radicular

Not characteristic

Sensibility

Brown Sequard

Disosiation of sensibility

Localization

Unilateral

Bilateral

LaboratoryX- ray : VertebraeMyelografi / CTMMMRI

Vascular disturbance : 1. Syndrome of ASA -Suddenly -Pain -Parese, first onset columna dorsalis still good. -Mostly lumbal area - Patomechanism : stroke like

Inflammation : -Myelitis : viral, immunologic reaction -Arachnoiditis : TBC

Trauma : -Mostly cervical area -Prohibition cervical movement -Fixation

Degeneration disease : -Amyotropic lateral sclerosis -Progressive spinal muscular atrofi - Primary lateral sclerosis -Tabes dorsalis

Decubitus : - Stad. 1 : inflammation, lost in 48 hours - Stad. 2 : Cutaneus - Stad. 3 : reach to the bone