Acute Medulla Compression

Definition
• Acute medulla compression is
suppression on medulla spinal because
trauma and disease certain that could
push medulla spinal and disturb function
normally
 Epidemiology
• prevalence (America) less more 200,000 patient,
approximately 10,000 died because complication that
related with injury medulla spinal,
• In Indonesia own, injury bone back that entry The
Hospital Dr. Soetomo average of 111 case per year, Since
year 1983-1997 there 1592 case that treated The
Hospital Dr. Soetomo Surabaya.
• trauma medulla spinal especially about person young, age
20-24 year, 65% case happen below age 35 year, often
happen on man of the woman (3-4: 1). Around 50% result
accident vehicle motorized, especially bike the motor
(40%), fall down (20%), Sports (13%), accident work (12%),
violence wound shoot or pricker (15%). locations most
often is C5, followed C4, C6, T12, C7 and L1.
 Etiology
Cause spinal cord injury, outline divided as follows:
 Pathophysiology
• contusions, lacerations, and compression substance medulla
(well false one or in combination)When hemorrhage happen
on area medulla spinal, blood could leak to extradural,
subdural or area subarachnoid on canal Spinal. after
happen contusions or rip result injury, fibers nerve start
swell and wrecked, Circulation blood to substance grisea
medulla spinal into disturbed, so that process pathogenic
considered cause damage that happen on injury medulla
spinal I, Something chain secondary events that inflict
ischemia, hypoxia, Edema, and lesions haemorrhagic, which
on turn result damage myelin and axons, Reaction
secondary this, believed into cause principle degeneration
medulla spinal on level injury,
 Symptoms
• back pain
• Weakness on leg will appear if not addressed
with carefully, begins with presence stiffness
and feeling want fall down (imbalance).
• abnormality sensory could appear, which begins
with disappearance flavor starts from foot,
then increase to to levels compression medulla.
• dysfunction otonom, with signs early is
disappearance control micturition, urgency,
• If Flow blood to medulla spinal disconnected,
then paralysis and disappearance flavor can
happen in time only some minute,
 Diagnosis
• diagnosis enforced by symptom and result
examination physical,
• Damage on chest part middle can cause
weakness and die flavor on leg and disruption
function digestion and uterus urine,
• CT scan or MRI can show locations suppression
and determine cause, Mielogram do for help
determine locations suppression, If examination
show presence growth abnormal, then need do
biopsy for determine is growth mentioned is
malignant or not,
• Laboratory • Radiology
• AGD • Photo plain
• content lactic • computed tomography
• content (CT) scanning
hemoglobin/hematocrit • Magnetic resonance
• urinalysis imaging (MRI)
 Management
• Pharmacology
- corticosteroid dose standard : 30 mg /kg, Bolus
IV for 15 minute, then interlude 5 minute, next
5.4 mg /kg/hour with infusion for 23 hours (if
therapy starts <3 hours of onset)
- Infuse methylprednisolon next for 48 hours if
therapy starts time 3-8 hours of onset
- contraindications : wound open because risks
infection and estimate effect drug more small
of the benefit
- Effect side : hypersensitivity, enhancement
risks infection
 Prognosis
• number hope life for patient with injury bone back
continue increase however still in under population
general,
• Patient aged 20 year have hope life around 35.7
year (patient with tetraplegia high 11 [C1-C4]),
• patients aged 40 year (patient with tetraplegia low
[C5-C8]), or 45.2 year (patient with paraplegia).
• Patient aged 60 year on time happen cedrea or
compression I medulla spinal have hope life around
7.7 year (patient with tetraplegia high), 9.9 year
(patient with tetraplegia low) and 12.8 year (patient
with paraplegia).