Gangguan mental organik pada multipel sklerosis

Abstract

Multipel sklerosis (MS) adalah penyakit demielinasi autoimun polifasik/multifokal menyerang substansia alba akibat autoreaktif limfosit. Perempuan lebih dominan dibanding lelaki. Manifestasi klinis berupa neuritis optik akut, gejala traktus piramidal dan ekstrapiramidal, sindrom lesi batang otak akut dan medula spinalis, serta gangguan mental organik relapsing remitting. Kasus seorang lelaki 22 tahun dengan riwayat neuritis optik akut mata kiri kemudian disusul mata kanan, selanjutnya kelemahan separuh tubuh kiri, perlahan-lahan memberat, lalu mengalami perbaikan dengan gejala sisa. Pada pemeriksaan fisis didapat hemiparesis spastik sinistra grade 4+, refleks Babinski dan Hoffmann-Tromner sinistra positif, serta gejala psikologis. Pemeriksaan penunjang MRI kepala dengan kontras tampak hiperintens T2 di paraventrikel lateral kanan kornu anterior dan posterior. Penderita didiagnosis MS dan gangguan mental organik, kemudian diterapi dengan citicoline 2x500 mg PO, mecobalamin 1x500 mcg PO, risperidone 1x2 mg PO, dan psikoedukasi keluarga. Respon terapi baik tetapi prognosis buruk.

Multiple sclerosis (MS) is a polyphasic/multifocal autoimmune demyelination disease which affect the substantia alba caused by autoreactive of lymphocyte. Women are more dominant than men. The clinical manifestation are acute optic neuritis, pyramidal and extrapyramidal tracts lesion, acute brain stem and spinal cord lesion syndrome, organic mental disorders which cause relapsing remitting. Case was a 22 years old male with history of acute optic neuritis on the left eye which slowly moves to the right eye, followed by weakness of the left part of the body, happens slowly and progressively worse and becomes better with squelle. On the physical examination, it was found spastic hemiparesis sinistra grade 4+, positive sinistra Babinski and Hoffmann-Trommner reflexes, and psychological manifestation. Head MRI scan with contrast showed hyperintense T2 at right lateral paraventricle of cornu anterior posterior. The diagnosis were MS and organic mental disorders, and treated with oral citicoline 2x500 mg, mecobalamin 1x500 mcg, risperidone 1x2 mg, and psychological education for the family. Response to therapy was good but the prognosis was poor.