pa 2-1 neuropatologi 2013
TRANSCRIPT
Pathology CNSNeuropathology
Oleh: dr. Cahyono Kaelan, Sp.PA(K), Sp.S
Topics
1. Neuronal Degeneration2. Congenital Abnormality (Hydrocephalus)3. Stroke (HS & NHS)4. Infection ( Encephalitis, Meningitis)
5. CNS Tumors 6.Degenerative Disease (AD & PD)
The anatomy of the brain
CNS Cellular• Neuron• Astrocytes• Oligodendroglia• Microglia• Ependym
NEURONAL DEGENERATION
Neuronal Degeneration
• Chromatolysis: is the dissolution of the Nissl bodies in the cell body of a neuron.
• Neurolysis:the breaking down of nervous tissue (as from disease or injury)
• Neurophagia: phagocytoses by microglia
CONGENITAL ABNORMALITY (HYDROCEPHALUS)
Congenital Abnormality (Hydrocephalus)
• Hydro = Water • Cephalus = Head• Infection within during pregnancy• Disturbing of CSF circulation
STROKE
Stroke
• HS = Hemorrhagic stroke• NHS = Non
Hemorrhagic stroke
HS
Etiologi HS
• Umumnya• Hiperte
nsi, • Aneuris
ma, • Malfor
masi arteriovenosa
• Dll. • EL-Mitwalli
& Malkoff, 2001, : • Hiperten
si • Alkohol• Tingkat
HDL• Obat-
obatan
NHS
• Thrombus • Emboli lepas akbt atrial fibrillasi, penyakit
jantung• Atherosclerosis =Perkapuran p.darah• DM• Hyperlipidaemia• Hypertensi• Dyscrasia darah (gangguan darah)
INFECTION( ENCEPHALITIS, MENINGITIS)
Infeksi ( Meningitis, Encephalitis )
• Radang selaput meninges• M-Purulenta• M-TBC• Panas tinggi• Kejang-kejang• Kesadaran menurun• Kaku kuduk• Slide ( Praktikum Meningitis Purulenta)
TUMORS
CNS Tumors (Neoplasma sesuai asalnya)
• Astrocytoma• Schwannoma• Oligodendroglioma• Ependymoma• Choroid plexius papiloma• Meningioma
klasifikasi• Grade I:
Pilocytic • Grade II: Diffuse• Grade III:
Anaplastic• Grade IV:
Glioblastoma
Astrositoma Grade 1
• Astrositoma pilositic berupa kistik dengan cairan kuning kecoklatan dan adanya nodul mural (mural nodule).
• Sel
Meningioma: • Pembungkus araknoid (arakhnoid cal cell)• >> jinak, Meningioma Malligna jarang (1-2% dari meningioma)• Insidens 20%• ♀> tu > 60 thn♂
Sign and symptom• Slow growing, and may grow to a large size before
causing symptoms. • The symptoms will depend on the location • The first symptoms are usually due to increased
pressure on the brain caused by the growing tumor. • Headache and weakness in an arm or leg are the most
common, although seizures, personality changes, or visual problems may also occur.
• Pain and loss of sensation or weakness in the arms or legs are the most common symptoms of spinal cord meningioma.
• Most people with meningiomas will have no symptoms.
Tekanan intra kranial & Herniasi
Penyebab Peninggian TIK :Brain edema, Tumor, Stroke (HS dan NHS),
Hydrocephalus, Trauma Perdarahan.TIK meninggi Herniasi (Penurunan bagian otak
ke bagian bawah / celah• Herniasi menekan batang otak pusat
pernapasan dan Jantung Kematian
Herniation
Supratentorial herniation1. Uncal (transtentorial)2. Central3. Cingulate (subfalcine)4. Transcalvarial
Infratentorial herniation5. Upward (upward cerebellar
or upward transtentorial)6. Tonsillar (downward cerebellar)
DEGENERATIVE DISEASE (ALZHEIMER’S DISEASE DAN PARKINSON DISEASE)
PathologyAD (Alzheimer’s Disease)
Atrofi lobus frontalis d temporalis
Parkinson Disease
Gejala (TRAP)• Tremor : resting tremor• Rigidity : cogwheel phenomena
(gerakan pasif, terputus2 dan langkah jalan cepat tp pendek (festination)
• Akinesia: mask face, hipofonia, drooling, mikrografia) dll
• Postural reflex terganggu: pull test
Gejala tambahan• motorik: freezing (bhenti
ditempat saat mau melangkah, sdg berjalan), start hesitation (ragu2 mulai melangkah), distonia ddl
• Otonom: konstipasi, impotensi seksual
• Mental: lambat berpikir, depresi, dementia
• Lain-lain:
Pathogenesis
• Degenerative (old), > 65 tahun• Genetics• Traumatic (repetitive injury / Pugulistic)• Post infections (Encephalitis)• Parkinsonism= Parkinson akibat obat2an
/psikotropika= usia muda (Bedakan dgn real PD)
Pathology PD
• Mid brain • Kerusakan Subtantia Nigra • Pigmented neuron• Levy body• Gliosis
for the attention