Pathology CNS

Neuropathology
Oleh:
dr. Cahyono Kaelan, Sp.PA(K), Sp.S
Topics
1. Neuronal Degeneration
2. 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
Hipertensi,
Aneurisma,
Malformasi
arteriovenosa
Dll.

EL-Mitwalli & Malkoff,
2001, :
Hipertensi
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 herniation
1. Uncal (transtentorial)
2. Central
3. Cingulate (subfalcine)
4. Transcalvarial

Infratentorial herniation
5. Upward (upward cerebellar
or upward transtentorial)
6. Tonsillar (downward cerebellar)


DEGENERATIVE DISEASE
(ALZHEIMERS DISEASE DAN PARKINSON
DISEASE)

Pathology
AD (Alzheimers 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




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