PA 2-1 Neuropatologi 2013

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