PRESENTASI KASUS BANGSAL

TETREPARESIS

Diajukan Kepada :
Dr. Gama Sita Setya P., Sp.S

Disusun Oleh :
Budi Nugraha
2007 031 0032

KEPANITERAAN KLINIK ILMU PENYAKIT SYARAF
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH YOGYAKARTA
BPRSUD SALATIGA
2011

LEMBAR PENGESAHAN
PRESENTASI KASUS BANGSAL
TETRAPARESIS

Telah disetujui dan dipresentasikan
Pada tanggal

Februari 2010

Menyetujui :

Dokter Pembimbing

(Dr. Gama Sita Setya P., Sp.S)

BAB I
TINJAUAN PUSTAKA
TETRAPARESIS
DEFINISI
Parese adalah kelemahan/kelumpuhan parsial yang ringan/tidak lengkap atau
suatu kondisi yang ditandai oleh hilangnya sebagian gerakan atau gerakan terganggu.
Kelemahan adalah hilangnya sebagian fungsi otot untuk satu atau lebih kelompok otot
yang dapat menyebabkan gangguan mobilitas bagian yang terkena. Parese pada anggota
gerak dibagi mejadi 4 macam, yaitu:
Monoparese adalah kelemahan pada satu ekstremitas atas atau ekstremitas bawah.
Paraparese adalah kelemahan pada kedua ekstremitas bawah.
Hemiparese adalah kelemahan pada satu sisi tubuh yaitu satu ekstremitas atas dan
satu ekstremitas bawah pada sisi yang sama.
Tetraparese adalah kelemahan pada keempat ekstremitas.
Tetraparese/Quadriparese adalah kelumpuhan/kelemahan yang disebabkan oleh
penyakit atau trauma pada manusia

yang menyebabkan hilangnya sebagian

fungsi

motorik pada keempat anggota gerak, dengan kelumpuhan/kelemahan lengan lebih atau
sama hebatnya dibandingkan dengan tungkai. Hal ini diakibatkan oleh adanya kerusakan
otak, kerusakan tulang belakang pada tingkat tertinggi (khususnya pada vertebra
cervikalis), kerusakan sistem saraf perifer, kerusakan neuromuscular atau penyakit otot.
kerusakan diketahui karena adanya lesi yang menyebabkan hilangnya fungsi motorik
pada keempat anggota gerak, yaitu lengan dan tungkai. Penyebab khas pada kerusakan ini

adalah trauma (seperti tabrakan mobil, jatuh atau sport injury) atau karena penyakit
(seperti mielitis transversal, polio, atau spina bifida).
Pada tetraparese kadang terjadi kerusakan atau kehilangan kemampuan dalam
mengontrol sistem pencernaan, fungsi seksual, pengosongan saluran kemih dan rektum,
sistem pernafasan atau fungsi otonom. Selanjutnya, dapat terjadi penurunan/kehilangan
fungsi sensorik. adapun manifestasinya seperti kekakuan, penurunan sensorik, dan nyeri
neuropatik. Walaupun pada tetraparese itu terjadi kelumpuhan pada keempat anggota
gerak tapi terkadang tungkai dan lengan masih dapat digunakan atau jari-jari tangan
yang tidak dapat memegang kuat suatu benda tapi jari-jari tersebut masih bisa
digerakkan, atau tidak bisa menggerakkan tangan tapi lengannya masih bisa digerakkan.
Hal ini semua tergantung dari luas tidaknyanya kerusakan.
EPIDEMIOLOGI
Tetraparese salah satunya disebabkan karena adanya cedera pada medula spinalis.
menurut Pusat Data Nasional Cedera Medula Spinalis (The National Spinal Cord Injury
Data Research Centre) memperkirakan ada 10.000 kasus baru cedera medula spinalis
setiap tahunnya di Amerika Serikat. Angka insidensi paralisis komplet akibat kecelakaan
diperkirakan 20 per 100.000 penduduk, dengan angka tetraparese 200.000 per tahunnya.
Kecelakaan kendaraan bermotor merupakan penyebab utama cedera medula spinalis.
Cedera medula spinalis dapat dibagi menjadi komplet dan tidak komplet
berdasarkan ada/tidaknya fungsi yang dipertahankan di bawah lesi. Pembagian ini
penting untuk meramalkan prognosis dan penanganan selanjutnya. Data di Amerika
Serikat menunjukkan urutan frekuensi disabilitas neurologis karena cedera medula
spinalis traumatika sbb : (1) tetraparese inkomplet (29,5%), (2) paraparese komplet

(27,3%), (3) paraparese inkomplet (21,3%), dan (4) tetraparese komplet (18,5%).
ETIOLOGI
Tabel 1. Penyebab umun dari tetraparesis :
Complete/incomplete transection of cord with fracture
Prolapsed disc
Cord contusion-central cord syndrome, anterior cord syndrome
Guillain-Barre Syndrome (post infective polyneuropathy)
Transverse myelitis Acute myelitis
Anterior spinal artery occlusion
Spinal cord compression
Haemorrhage into syringomyelic cavaty
Poliomyelitis
PATOFISIOLOGI
Tetraparese dapat disebabkan karena kerusakan Upper Motor Neuron (UMN)
atau kerusakan Lower Motor Neuron (LMN). Kelumpuhan/kelemahan yang terjadi pada
kerusakan Upper Motor Neuron (UMN) disebabkan karena adanya lesi di medula
spinalis. Kerusakannya bisa dalam bentuk jaringan scar, atau kerusakan karena tekanan
dari vertebra atau diskus intervetebralis. Hal ini berbeda dengan lesi pada LMN yang
berpengaruh pada serabut saraf yang berjalan dari kornu anterior medula spinalis sampai
ke otot.
Pada columna vertebralis terdapat nervus spinalis, yaitu nervus servikal, thorakal,
lumbal, dan sakral. Kelumpuhan berpengaruh pada nervus spinalis dari servikal dan

dan sensorik yang dipersarafinya. organ. 010009000003a7f700000000237c000000001610000026060f002220574d464301000000000 001007cef00000000080000000020000094ca000094ea0000010000006c00000000000000000 00000bd0000006e0000000000000000000000341a0000480f000020454d460000010094ea00 000f000000010000000000000000000000000000000005000020030000c40100001a0100000 00000000000000000000000e3e306006e4e0400460000002c00000020000000454d462b0140 01001c000000100000000210c0db01000000600000006000000046000000e4380000d838000 0454d462b224004000c000000000000001e4009000c00000000000000244001000c00000000 0000003040020010000000040000000000803f214007000c000000000000000840000530380 000243800000210c0db01000000000000000000000000000000000000000100000089504e47 0d0a1a0a0000000d49484452000000be0000006f080600000052167a1700000006624b47440 0ff00ff00ffa0bda7930000000774494d4507d80b0600051ee77a93090000200049444154789c ed9d797853d5d6877f27739a26e994a6234de7b9a585b6cc8350442920888aa8f753e12a8823c e5ef43a5d5041b9a282332a2820a0280282cc50660a1d286de9dca4f33ca469a6f3fdb193369dd 3342de0cdfb3c7d7a7a867d76d275f6597badb5d7026cd8b061c3860d1b366cd8b061c3c64d0e 1d35b4e7dffa306e74076c58139a0dd023013c00d014d9a61d015a02d0fe00cd03e818c36f164 . Lesi pada UMN dapat menyebabkan parese spastic sedangkan lesi pada LMN menyebabkan parese flaccid. Lesi komplit dapat menyebabkan kehilangan kontrol otot dan sensorik secara total dari bagian dibawah lesi. Wilayah ini penting.lumbosakral dapat menyebabkan kelemahan/kelumpuhan pada keempat anggota gerak. jika terjadi kerusakan pada daerah ini maka akan berpengaruh pada otot. sedangkan lesi inkomplit mungkin hanya terjadi kelumpuhan otot ringan (parese) dan atau mungkin kerusakan sensorik. Ada dua tipe lesi. yaitu lesi komplit dan inkomplit.

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Disamping itu kelompok motoneuron yang berada didalam segmen C5 kebawah ikut rusak. Dibawah ini kelumpuhan Lower Motor Neuron (LMN) akan diuraikan menurut . Lesi di Low cervical cord Lesi transversal yang merusak segmen C5 ke bawah itu tidak saja memutuskan jaras kortikospinal lateral. yaitu sebagian otot-otot kedua lengan yang berasal yang berasal dari miotom C6 sampai miotom C8. lalu otot-otot thoraks dan abdomen serta segenap otot kedua tungkai yang mengakibatkan kelumpuhan parsial dan defisit neurologi yang tidak masif di seluruh tubuh.563355f3563345f3563355f3563345f3563355f3563345f3563786bde7bbd77bd77bd77de7bbd 77bd77bd77de7bbd77bd77bd771042ff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7f ff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7fff7 Gambar 3. Lesi yang terletak di medula spinalis tersebut maka akan menyebabkan kelemahan/kelumpuhan keempat anggota gerak yang disebut tetraparese spastic. Ini berarti bahwa pada tingkat lesi kelumpuhan itu bersifat Lower Motor Neuron (LMN) dan dibawah tingkat lesi bersifat Upper Motor Neuron (UMN).or upper cervical cord Tiap lesi di medula spinalis yang merusak daerah jaras kortikospinal lateral menimbulkan kelumpuhan Upper Motor Neuron (UMN) pada otot-otot bagian tubuh yang terletak di bawah tingkat lesi. melainkan ikut memotong segenap lintasan asendens dan desendens lain. Lesi transversal medula spinalis pada tingkat servikal. Lesi di Mid. Lesi pada Lower motor neuron (LMN). misalnya C5 mengakibatkan kelumpuhan Upper Motor Neuron (UMN) pada otot-otot tubuh yang berada dibawah C5.

sindrom lesi yang selektif merusak motoneuron dan jaras kortikospinal. namun yang berada di intumesensia servikalis dan lumbosakralis paling berat mengalami kerusakan. walaupun segenap radiks (ventralis/dorsalis) terkena. Kerusakan pada radiks ventralis (dan dorsalis) yang reversibel dan menyeluruh dapat terjadi. sindrom lesi yang merusak motoneuron dan funikulus anterolateralis dan sindrom lesi di substantia grisea sentralis . Penyakit di otot bisa berupa miopati dan distrofi. Kelainan fungsional sistem saraf tepi dapat disebabkan kelainan pada saraf di sumsum tulang belakang atau kelainan sepanjang saraf tepi sendiri. sehingga di dalam klinik dikenal sindrom lesi di kornu anterius. Pada umumnya bermula dibagian distal tungkai kemudian bergerak ke bagian proksimalnya. Karena serabut otot rusak. dapat menyebabkan kelemahan di .komponen-komponen Lower Motor Neuron (LMN). Salah satu penyakit dengan lesi utama pada neuron saraf perifer adalah polineuropati. kontraktilitasnya hilang dan otot tidak dapat melakukan tugasnya. Kerusakan itu merupakan perwujudan reaksi imunopatologik. Kelumpuhannya meluas ke bagian tubuh atas. Karena daerah ini yang mengurus anggota gerak atas dan bawah. Pada umumnya motoneuron-motoneuron yang rusak didaerah intumesensia servikal dan lumbalis sehingga kelumpuhan LMN adalah anggota gerak. terutama otot-otot kedua lengan. Lesi di otot dapat berupa kerusakan struktural pada serabut otot atau selnya yang disebabkan infeksi. misalnya poliomielitis. Lesi ini biasanya disebabkan karena adanya infeksi. Motoneuron-motoneuron berkelompok di kornu anterius dan dapat mengalami gangguan secara selektif atau terlibat dalam satu lesi bersama dengan bangunan disekitarnya. intoksikasi eksogen/endogen. dan degenerasi herediter.

KLASIFIKASI Pembagian tetraparese berdasarkan kerusakan topisnya: Tetraparese spastik Tetraparese spastik terjadi karena kerusakan yang mengenai upper motor neuron (UMN). DIAGNOSIS BANDING a. Pada penderita distrofia musculorum enzim kreatinin fosfokinase dalam jumlah yang besar.keempat anggota gerak biasanya bagian proksimal lebih lemah dibanding distalnya. sehingga menyebabkan penurunan tonus atot atau hipotoni. penjalaran osteomielitis atau perluasan proses meningitis piogenik. Tetraparese flaksid Tetraparese flaksid terjadi karena kerusakan yang mengenai lower motor neuron (LMN). infeksi dapat langsung terjadi melalui emboli septik. Istilah mielitis tidak hanya digunakan jika medula spinalis mengalami peradangan. namun juga jika lesinya . luka terbuka ditulang belakang. Penyakit infeksi - Mielitis transversa Dapat menyebabkan satu sampai dua segmen medula spinalis rusak sekaligus. sebelum terdapat manifestasi dini kadar enzim ini di dalam serum sudah jelas meningkat. akan tetapi mengapa enzim ini dapat beredar didalam darah tepi masih belum diketahui. sehingga menyebabkan peningkatan tonus otot atau hipertoni.

Kekurangan vitamin B bisa mengenai saraf perifer di seluruh tubuh. bahan racun bisa melukai saraf perifer dan menyebabkan polineuropati atau mononeuropati (lebih jarang). Pada saat itu sarang-sarang reaksi imunopatologik yang berukuran kecil tersebar secara difus sepanjang medula spinalis. Poliomielitis Poliomielitis adalah peradangan pada daerah medula spinalis yang mengenai substantia grisea. Jika lesi mengenai medula spinalis setinggi servikal atas maka dapat menyebabkan kelemahan pada anggota gerak atas dan bawah . kadang karena racun yang dihasilkan oleh beberapa bakteri (misalnya pada difteri) atau karena reaksi autoimun. Polineuropati Polineuropati adalah kelainan fungsi yang berkesinambungan pada beberapa saraf perifer di seluruh tubuh.mengalami peradangan dan disebabkan oleh proses patologik yang mempunyai hubungan dengan infeksi. Tahap kelumpuhan bermula pada akhir tahap nyeri muskular. kekurangn gizi dan kelainan metabolik juga bisa menyebabkan polineuropati. Serabut-serabut asenden dan desenden panjang dapat terputus oleh salah satu lesi yang tersebar luas. kanker bisa menyebabkan polineuropati dengan menyusup langsung ke dalam saraf atau menekan saraf atau melepaskan bahan racun. sehingga dapat menimbulkan kelumpuhan parsial dan defisit sensorik yang tidak masif di seluruh tubuh atau yang dikenal dengan istilah tetraparese. Anggota gerak yang dilanda kelumpuhan LMN adalah ekstremitas. Adakalanya reaksi imunologik timbul di medula spinalis setelah beberapa minggu sembuh dari penyakit viral. b. Pada umumnya kelompok motoneuron di segmen-segmen intumesensia servikal dan lumbalis merupakan substrat tujuan viral. penyakit yang bisa . Penyebab karena infeksi bisa menyebabkan polineuropati.

Pada akhirnya akan terjadi kelemahan otot dan atrofi (penyusutan otot). Ketidakmampuan untuk merasakan posisi sendi menyebabkan ketidakstabilan ketika berdiri dan berjalan. kelumpuhan otot biasanya bilateral dan simetris dengan tipe "lower motor neuron dengan penyebaran kelumpuhan yang bersifat ascending yaitu mulai dari ekstrimitas bawah yang menjalar ke ekstrimitas atas. nyeri terbakar dan ketidakmampuan untuk merasakan getaran atau posisi lengan. hari ke sebelas timbul fagosit dan pada hari ketiga belas proliferasi Schwan sel. dan kadang-kadang juga saraf kranialis. yang biasanya timbul setelah suatu infeksi. Pada hari ke sembilan timbul limfosit. Kesemutan. . gagal ginjal dan kekurangan gizi (malnutrisi) yang berat. Hari ke lima terjadi desintegrasi myelin dan pembengkakan aksis silinder. Kelainan pada saraf perifer dijumpai sebagai berikut : tiga sampai empat hari pertama pembengkakan dan menjadi irreguler dari selubung myelin. tetapi bisa pula descending yaitu mulai dari ekstrimitas atas yang turun ke ekstrimitas bawah. Kelumpuhan biasanya timbul sesudah tidak ada panas. Nyeri seringkali bertambah buruk di malam hari dan bisa timbul jika menyentuh daerah yang peka atau karena perubahan suhu. mati rasa. tungkai dan sendi merupakan gejala utama dari polineuropati kronik. Polineuropati kronik cenderung berkembang secara lambat (sampai beberapa bulan atau tahun) dan biasanya dimulai di kaki (kadang di tangan).menyebabkan polineuropati kronik (menahun) adalah diabetes. Sindrom Guillain Barre (SGB) Sindroma Guillain Barre (SGB) adalah suatu kelainan sistem saraf akut dan difus yang mengenai radiks spinalis dan saraf perifer. Manifestasi klinis utama dari SGB adalah suatu kelumpuhan yang simetris tipe lower motor neuron dari otot-otot ekstremitas.

Secara patologis ditemukan degenerasi mielin dengan edema yang dapat atau tanpa disertai infiltrasi sel. makrofag. kelompok otot-otot di sekitar persendian bahu dan pinggul. serta sel . Sel-sel infiltrat terutama terdiri dari sel limfosit berukuran kecil. infeksi virus. Di negara-negara tropik penyebabnya adalah infeksi tuberkulosis. sifilis ataupun trauma pada medula spinalis. Karena tidak segenap radiks ventralis terkena jiratan. sedang dan tampak pula. Infeksiinfeksi meningokokus. namun kebanyakan pada yang berkelompokan saja. Pada tempat-tempat tertentu perlekatan pasca infeksi itu dapat menjirat radiks ventralis (sekaligus radiks dorsalis). Infiltrasi terdiri atas sel mononuklear.badan dan kadang-kadang juga muka. Sindrom Guillain Barr Akibat suatu infeksi atau keadaan tertentu yang mendahului SGB akan timbul autoantibodi atau imunitas seluler terhadap jaringan sistim saraf-saraf perifer. dapat menimbulkan perlekatan-perlekatan selaput araknoid. maka radiks-radiks yang diinstrumensia servikalis dan lumbosakralis saja yang paling umum dilanda proses perlekatan pasca infeksi. Kelumpuhan tersebut bergandengan dengan adanya defisit sensorik pada kedua tungkai atau otot-otot anggota gerak. Oleh karena itu kelumpuhan LMN paling sering dijumpai pada otot-otot anggota gerak.

atau bagian distal lebih berat dari bagian proksimal. Kelelahan/kelemahan ini disebabkan karena sirkulasi antibodi yang memblok acetylcholine receptors pada post sinaptik neuromuscular junction. stimulasi penghambatan ini berpengaruh pada neurotransmiter asetilkolin. anggota gerak atas dan saraf kranialis. kelemahan otot pada lengan dan tungkai. Serabut saraf mengalami degenerasi segmental dan aksonal. Setelah itu muncul sel plasma dan sel mast. Lesi ini bisa terbatas pada segmen proksimal dan radiks spinalis atau tersebar sepanjang saraf perifer. Manifestasi klinis utama adalah kelumpuhan otot-otot ekstremitas tipe lower motor neuron. Kadang-kadang juga bisa keempat anggota gerak dikenai secara serentak. Manifestasi klinisnya dapat berupa kelemahan pada otot yang mengatur pergerakan mata. kemudian menyebar ke badan dan saraf kranialis.polimorfonuklear pada permulaan penyakit. Biasanya derajat kelumpuhan otot-otot bagian proksimal lebih berat dari bagian distal. dan disartria. Predileksi pada radiks spinalis diduga karena kurang efektifnya permeabilitas antara darah dan saraf pada daerah tersebut. Kelumpuhan otot-otot ini simetris dan diikuti oleh hiporefleksia atau arefleksia. disfagia. d. Pada sebagian besar penderita kelumpuhan dimulai dari kedua ekstremitas bawah kemudian menyebar secara asenden ke badan. . Miastenia Grafis Miastenia grafis adalah penyakit neuromuskular yang menyebabkan otot skelet menjadi lemah dan lekas lelah. tapi dapat juga sama beratnya. perubahan ekspresi wajah.

menyebabkan Kelemahan pada otot dan dapat berakhir pada kematian. Kondisi tersebut menyebabkan degenerasi saraf motorik bagian atas (brain) dan saraf motorik bagian bawah (spinal cord) dengan kombinasi tanda upper motor neuron (UMN) dan lower motor neuron (LMN). Penurunan kualitas saraf ini. Amyotrophic Lateral Sclerosis (ALS) Penyakit Amyotrophic Lateral Sclerosis (ALS) adalah suatu kelainan yang progresif dari sistem saraf yang banyak terjadi pada orang dewasa dengan penyakit motoneuron.Miastenia Gravis e. .

Karena otot yang berada dalam tubuh kehilangan pemasok nutrisinya.Amyotrophic Lateral Sclerosis Proses degenerasi hanya menyerang pada neuron motorik. dan sebagainya. Akibat kelemahan itu. Saraf-saraf di dalam sistem . yaitu sel-sel saraf yang mengatur pergerakkan otot. penyakit ALS menyebabkan saraf–saraf motorik yang berada di otak dan batang tubuh mengecil. Namun penyakit ini tidak mempengaruhi saraf sensoris (perasa) dan fungsi mental. menjentik. menggaruk. otot – otot tubuh tidak lagi mendapat sinyal untuk bergerak. seperti molekul radikal bebas dan kalsium kemungkinan juga ikut terlibat. memegang. dan pada akhirnya menghilang. teori yang dikenal saat ini menyatakan neurotransmiter glutamat (suatu zat kimia yang menghantarkan impuls atau sinyal ke sel-sel saraf) kemungkinan memegang peranan sebagai penyebab matinya sel-sel saraf motorik. Misalnya. kemampuan tubuh untuk mengatur gerakan otot yang disadari akan hilang secara perlahan-lahan. Seiring berjalannya waktu. Meskipun penyebab pasti ALS belum diketahui. Penyakit ALS mengakibatkan sistem neuromuscular tidak berfungsi karena kedua saraf motorik penderita ALS telah rusak. Zat-zat kimia lainnya. sehingga otot–otot yang menjadi lebih kecil dan melemah. Akibatnya.

sehingga menyebabkan kelainan fungsi. Spondilosis Servikalis Spondilosis servikalis menyebabkan menyempitnya kanal spinalis (tempat lewatnya medula spinalis) di leher dan menekan medula spinalis atau akar saraf spinalis.neuromuscular yang memberi nutrisi ke otot-otot tersebut terlokalisir. Jika terjadi penekanan medula spinalis. maka . Gejalanya bisa menggambarkan suatu penekanan medula spinalis maupun kerusakan akar sarafnya. sehingga menyebabkan tumbuhnya jaringan yang rusak mengantikan saraf–saraf yang normal. f. Spondilosis servikalis merupakan suatu penyakit yang menyerang usia pertengahan dan usia lanjut. dimana diskus dan tulang belakang di leher mengalami kemunduran (degenerasi).

90-95% disebabkan oleh mikobakterium tuberkulosis tipik (2/3 dari tipe human dan 1/3 dari tipe bovin) dan 5-10% oleh mikobakterium tuberkulosa atipik. Spondilitis tuberkulosa merupakan 50% dari seluruh tuberkulosis tulang dan sendi. tertidur lama selama beberapa tahun.3. Oleh karena itu disebut pula sebagai Basil Tahan Asam (BTA). Leher terasa nyeri.2. karena keadaan umum yang buruk maka dapat terjadi basilemia.pertanda awalnya biasanya adalah perubahan pada cara berjalan. Basil TB dapat tersangkut di paru. Gerakan kaki menjadi kaku dan penderita berjalan dengan goyah. mempunyai sifat khusus yaitu tahan terhadap asam pada pewarnaan. paraplegi Pott. respons imunologik timbul dan fokus tadi dapat mengalami reaksi selular yang kemudian menjadi tidak aktif atau mungkin . Spondilitis tuberkulosa dikenal juga sebagai penyakit Pott. g. ginjal dan tulang.(1. Kelemahan dan penciutan otot pada salah satu atau kedua lengan bisa terjadi sebelum maupun sesudah timbulnya gejala penekanan medula spinalis. Penyebaran terjadi secara hematogen. Spondilitis Tuberkulosa Tuberkulosis tulang belakang atau dikenal juga dengan spondilitis tuberkulosa merupakan peradangan granulomatosa yang bersifat kronik destruktif yang disebabkan oleh mikobakterium tuberkulosa. Basil TB masuk ke dalam tubuh sebagian besar melalui traktus respiratorius.4). hati limpa. teutama jika akar sarafnya terkena. Kuman TB cepat mati dengan sinar matahari langsung. Spondilitis ini paling sering ditemukan pada vertebra T8-L3 dan paling jarang pada vertebra C1-2. 6 hingga 8 minggu kemudian. tetapi dapat bertahan hidup beberapa jam di tempat yang gelap dan lembab. Kuman ini berbentuk batang. Pada saat terjadi infeksi primer. Dalam jaringan tubuh kuman ini dapat dorman. Tuberkulosis tulang belakang merupakan infeksi sekunder dari tuberkulosis di tempat lain di tubuh.

kaseosa. Kemudian eksudat (yang terdiri atas serum. bagian depan. Selanjutnya terjadi kerusakan pada korteks epifise. Abses dapat berjalan ke mediastinum mengisi tempat trakea. atau daerah epifisial korpus vertebra. Abses pada daerah ini dapat menekan medulla spinalis sehingga timbul paraplegia. leukosit. Pada daerah servikal. Berbeda dengan infeksi lain yang cenderung menetap pada vertebra yang bersangkutan. esophagus. Abses pada vertebra torakalis biasanya tetap tinggal pada daerah toraks setempat menempati daerah paravertebral. Abses pada daerah lumbal dapat menyebar masuk mengikuti muskulus psoas dan muncul di bawah ligamentum inguinal pada bagian medial paha.sembuh sempurna. atau kavum pleura. Penyakit ini paling sering menyerang korpus vertebra. Vertebra merupakan tempat yang sering terjangkit tuberkulosis tulang. Infeksi berawal dari bagian sentral. discus intervertebralis dan vertebra sekitarnya. Penyakit ini pada umumnya mengenai lebih dari satu vertebra. tuberkulosis akan terus menghancurkan vertebra di dekatnya. Kemudian terjadi hiperemi dan eksudasi yang menyebabkan osteoporosis dan perlunakan korpus. Kerusakan pada bagian depan korpus ini akan menyebabkan terjadinya kifosis yang dikenal sebagai gibbus. berbentuk massa yang menonjol dan fusiform. di bawah ligamentum longitudinal anterior dan mendesak aliran darah vertebra di dekatnya. Eksudat ini dapat menembus ligamentum dan berekspansi ke berbagai arah di sepanjang garis ligament yang lemah. tulang yang fibrosis serta basil tuberkulosa) menyebar ke depan. eksudat terkumpul di belakang fasia paravertebralis dan menyebar ke lateral di belakang muskulus sternokleidomastoideus. Eksudat juga dapat menyebar ke daerah krista iliaka dan mungkin dapat mengikuti pembuluh darah femoralis pada trigonum . Eksudat dapat mengalami protrusi ke depan dan menonjol ke dalam faring yang dikenal sebagai abses faringeal.

Pemeriksaan penunjang : Foto vertebrae servikal/lumbal→untuk mengetahui adanya trauma.skarpei atau region glutea. Elektromiografi→menunjukan adanya fibrilasi. juga dipercaya dapat menghasilkan . Namun dapat dilakukan terapi umum sebagai berikut: Medikamentosa Kortikosteroid→ untuk mengurangi nyeri. atrofi dan denervasi (pada penyakit ALS) MRI PENATALAKSANAAN Penatalaksanaan dilakukan berdasarkan penyebabnya. penyempitan maupun pergeseran susunan tulang belakang. fasikulasi. riwayat penyakit dahulu dan riwayat penyakit keluarga). Fungsi lumbal→untuk menyingkirkan beberapa penyakit pembanding seperti sindrom guillain barr→adanya peningkatan protein sito albumin yang disertai peningkatan jumlah selnya. DIAGNOSIS Diagnosis ditegakkan berdasarkan : Anamnesis (Riwayat penyakit sekarang.

Diagnosis sedini mungkin dan dengan pengobatan yang tepat. seperti apa yang biasanya dilakukan sendiri. Penyakit dapat kambuh jika pengobatan tidak teratur atau tidak dilanjutkan setelah beberapa saat. makan. prognosisnya baik meskipun tanpa tindakan operatif. . PROGNOSIS Prognosis penderita dipengaruhi oleh pengobatan terhadap penyebab tetraparesis itu sendiri. melatih kekuatan duduk. Melakukan kegiatan sehari-hari sendiri. ROM (range of motion) dan meningkatkan kekuatan otot ekstremitas atas dan bawah. Antidiabetika→ pada kasus-kasus yang diperburuk oleh penyakit diabetes mellitus. Memperbaiki keadaan umum penderita 3. sosial.perbaikan neurologis. komunikasi. AKS/ADL secara luas berkaitan dengan aspek psikologis. Program : Melatih pasien untuk latihan bekerja. Terapi konservatif a. I. Terapi Okupasi Problem : agak kesulitan melakukan pekerjaan yang biasanya dilakukan sendiri karena terlalu lama berbaring. berdiri dan berjalan. Memberi korset yang mencegah gerakan vertebra /membatasi gerak vertebra c. Assesment: Pasien mengalami deconditioning syndrome. misalnya berpakaian.Tirah baring (bed rest) b. dan tanpa bantuan orang lain. dan rawat diri. Fisioterapi : Program : Infra Red.

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