You are on page 1of 71

DEPARTEMEN PATOLOGI

ANATOMI
FAKULTAS KEDOKTERAN
UNIVERSITAS SUMATERA UTARA
MEDAN

CNS
Kumpulan dari neuron = nuclei

04/11/15

PNS
Kumpulan neuron = ganglia

DEP. PATOLOGI ANATOMI FK-USU


2013

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

BRAIN

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

Have :
Cell body
Dendrites
intergrating
signals
Axon

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

Glial divided into :

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

CELLULAR
REACTIONS
Neurons
Acute (RED neuron, karyolysis)
Subacute, chronic, cell loss, gliosis
Axonal
Inclusions (lipid, prot., carb., viruses)

Glia,

gliosis

Swelling
Fibers
Inclusions
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

10

ACUTE NEURONAL INJURY


RED NEURONS
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

11

Hallmark Chronic CNS inju


Neuronal loss
&
Gliosis

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

12

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

13

Normal motor
units :
Two adjacent motor units

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

14

Abnormal motor
units
Segmental demyelination:

Random internodes of myelin are injured

Remyelinated by multiple Schwann cells

Axon & myocytes remain


intact

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

15

Abnormal motor
units
Axonal degeneration:
Axon & myelin sheath
undergo anterograde
degeneration (green)
Resulting :

Denervation atrophy
of the myocytes within
its motor unit

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

16

Abnormal motor
units
Reinnervation of muscle:

Sprouting of adjacent (red)


uninjured motor axons
leads to fiber type
grouping of myocytes
Injured axon attempts
axonal sprouting

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

17

Abnormal motor
units
Myopathy :

Scattered myocytes of
adjacent motor units are
small (degenerated /
regenerated)
Neurons & nerve fibers are
normal

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

18

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

19

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

20

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

21

PERIPHERAL NERVE
Same categories of
disease as other
tissues

The pattern of disease,


reflects the unique structure & function of
nerves
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

22

INFLAMMATORY
NEUROPATHIES
Characterized by inflammatory cell infiltrates in :

Immune mechanisms
presumed to be the primary cause of the inflammation
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

23

Immune-Mediated
Neuropathies

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

24

Is a life-threatening disease PNS

Incidence
(U.S.) 1 -3 /
100.000
persons

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

25

Guillain-Barr Syndrome

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

26

In some patients :

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

27

INFECTIOUS
POLYNEUROPATHIES
Many infectious processes affect peripheral nerve

Cause unique and specific pathologic


changes in nerves
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

28

Biopsies of sural nerves show :

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

29

Leprosy
Peripheral
nerve

04/11/15

involvement
in

DEP. PATOLOGI ANATOMI FK-USU


2013

Lepromatous &
tuberculoid
leprosy

30

Diphtheria
Peripheral
nerve
involvement

04/11/15

Effects of diphtheria
exotoxin

DEP. PATOLOGI ANATOMI FK-USU


2013

31

Earliest changes seen in :


Sensory ganglia

Incomplete blood-nerve barrier


allows entry of the toxin
Selective demyelination of axons
extends into adjacent anterior &
posterior roots (mixed sensorimotor
nerves)
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

32

Varicella zoster
The most common viral infections of
PNS

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

33

Varicella zoster

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

34

Varicella zoster

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

35

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

36

Classical Disease
Patterns
Degenerative
Inflammatory
Neoplastic

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

37

Classical CNS Disease


Patterns

Degenerative
Inflammatory
Neoplastic
Traumatic
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

38

CNS
MALFORMATIONS

Neural Tube

Anencephaly, Encephalocele, Spina Bifida

Forebrain
Polymicrogyria, Holoprosencephaly,
Agenesis of Corpus Callosum

Posterior Fossa (Infratentorial)


Arnold Chiari (infratentorial herniation),
Dandy-Walker (cerebellar cyst)

Syringomyelia/Hydromyelia
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

39

Fetal -protein in :
Amniotic fluid &
Maternal circulation
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

40

SPINA
BIFIDA

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

41

POLYMICROGYRIA
Small gyri

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

42

HOLOPROSENCEPHALY

Failure prosencephalon to develop, and separate, often leads to cyclops.

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

43

CEREBRAL
EDEMA
(Normal weight 1200-1300
grams)

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

44

CEREBRAL EDEM

Gyrus mendatar
Sulcus menyempit
Rongga ventrikel
tertekan

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

45

CEREBRAL
EDEMA

Subfalcine (SUPRAtentorial)
Cingulate (TENTORIAL)
Cerebellar tonsilar (SUBtentorial, or INFRAtentorial)
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

46

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

47

CEREBRAL
EDEMA

D.D.:

SYMPTOMS

EVERYTHIN
G

04/11/15

HEADACHE
HALLUCINATI
ONS
COMA
DEATH

DEP. PATOLOGI ANATOMI FK-USU


2013

48

HYDROCEPHALU
S
Impaired RESORPTION
Increased PRODUCTION

OBSTRUCTION

COMMUNICATING (entire)
NON-COMMUNICATING (part)
HIGH Pressure
NORMAL Pressure

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

50

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

51

PERINATAL Brain
Injuries
Three most
common
types of
perinatal
brain
injuries

Intraparenchymal
Hemorrhage
Intraventricular hemorrhage
(premies)
Periventricular leukomalacia
(i.e., infarcts)
Cerebral Palsy
refers to non-progressive diffuse cerebral
pathology apparent at childbirth
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

53

Various patterns of CNS injury in newborn

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

54

CNS TRAUMA
Skull Fractures
Parenchymal Injuries
Traumatic Vascular
Injury
Sequelae
Spinal Cord Trauma
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

55

BRAIN TRAUMA
Contusion (bruise)
Laceration (tear)
Coup/Contre-Coup
Concussion
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

56

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

57

Skull fracture types

HAIRLINE
04/11/15

DEPRESSED,
aka
DISPLACED

DEP. PATOLOGI ANATOMI FK-USU


2013

58

HEMATOMAS/HEMORR
HAGE
EPIDURAL (fx)
SUBDURAL (trauma No fx)
SUBARACHNOID (arterial, no
trauma)
INTRAPARENCHYMAL (any)
INTRAVENTRICULAR (no
trauma, rare in adults,
common in premies)
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

59

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

60

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

61

EPIDURAL HEMATOMA

The lucid interval is a classic feature of


the epidural hematoma

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

62

SUBDURAL HEMATOMA
04/11/15

No lucid interval, but instead a


sudden & progressive worsening of
DEP. PATOLOGI ANATOMIsymptoms
FK-USU
63
2013

04/11/15

SUBARACHNOID
DEP. PATOLOGI ANATOMI FK-USU
2013

64

04/11/15

INTRAPARENCHYMAL
DEP. PATOLOGI ANATOMI FK-USU
2013

65

SPINAL CORD
TRAUMA

Parallels BRAIN patterns of


injury on a cellular basis
Usually secondary to spinal
column displacement
Level of injury mirrors
motor loss: Death
Quadriplegia Paraplegia
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

68

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

69

Cerebrovascular
Diseases
(CVA, Stroke)

Ischemic ( blood and 02)


Global
Focal (regional):

ACUTE: edema neuronal microvacuolization


pyknosis karyorrhexis neutrophils

CHRONIC: macrophages gliosis

Hemorrhagic (rupture of
artery/aneurysm)
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

70

HYPERTENSIVE
CVA

Intracerebral
Basal Ganglia
Region

(lenticulostriate arteries of internal


capsule, putamen)

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

71

SUBARACHNOID
HEMORRHAGE
Rupture of large intracerebral
arteries which are the primary
branches of the anatomical
circle (of Willis)
Congenital (berry
aneurysms)
Atherosclerotic (atherosclerotic
aneurysms, or direct wall
rupture)
04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

74

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

75

CNS DEGENERATIVE
DISEASES

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

76

THANK YOU
SELAMAT BELAJAR

04/11/15

DEP. PATOLOGI ANATOMI FK-USU


2013

81