DEPARTEMEN PATOLOGI ANATOMI

FAKULTAS KEDOKTERAN
UNIVERSITAS SUMATERA UTARA MEDAN
2014
 CNS PNS
Kumpulan dari neuron = nuclei Kumpulan neuron = ganglia

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PERIPHERAL NERVE

The pattern of disease,

reflects the unique structure & function of nerves
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 INFLAMMATORY NEUROPATHIES
Characterized by inflammatory cell infiltrates in :

‘Immune mechanisms’
presumed to be the primary cause of the inflammation

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 Immune-Mediated Neuropathies

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… Guillain-Barré Syndrome

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 In some patients :

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 INFECTIOUS POLYNEUROPATHIES
Many infectious processes affect peripheral nerve

Cause unique and specific pathologic changes in

nerves

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 Biopsies of sural nerves show :

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 Leprosy

Lepromatous &
Peripheral nerve involvement in tuberculoid leprosy

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 Diphtheria
Peripheral nerve Effects of diphtheria exotoxin
involvement

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• 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)

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 Varicella zoster
The most common viral infections of PNS

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… Varicella zoster

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… Varicella zoster

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 Classical CNS Disease Patterns

• Degenerative
• Inflammatory
• Neoplastic
• Traumatic
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 BRAIN

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 CELLULAR REACTIONS
• Neurons
– Acute (RED neuron, karyolysis)
– Subacute
– Chronic (cell loss, gliosis)
– Axonal Inclusions (lipid, protein, carbohidrate,
viruses)

• Glia, “gliosis”
– Swelling
– Fibers
– Inclusions
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 ACUTE NEURONAL INJURY
“RED” NEURONS
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 Hallmark “Chronic” CNS injury

Neuronal loss
&
Gliosis

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 CNS MALFORMATIONS

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 Fetal α-protein in :
•Amniotic fluid &
•Maternal circulation
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 SPINA
BIFIDA

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 POLYMICROGYRIA
Small gyri

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 HOLOPROSENCEPHALY
Failure prosencephalon to develop, and separate, often leads to cyclops.
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 CEREBRAL EDEMA
(Normal weight 1200-1300 grams)

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 CEREBRAL EDEMA

• Gyrus mendatar
• Sulcus menyempit
• Rongga ventrikel tertekan

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 CEREBRAL EDEMA
• Subfalcine (SUPRA-tentorial)
• Cingulate (TENTORIAL)
• Cerebellar tonsilar (SUB-tentorial, or
INFRA-tentorial)

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 (SUPRA-tentorial)

(SUB-tentorial / INFRA-tentorial)
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 CEREBRAL EDEMA
• D.D.: • SYMPTOMS
– EVERYTHING – HEADACHE
– HALLUCINATIONS
– COMA
– DEATH

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 HYDROCEPHALUS

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 HYDROCEPHALUS
• Impaired RESORPTION
• Increased PRODUCTION

• OBSTRUCTION
• COMMUNICATING (entire)
• NON-COMMUNICATING (part)
• HIGH Pressure
• NORMAL Pressure
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 Fontanelle closure is the key factor whether
hydrocephalus will result in any cranial enlargement

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 PERINATAL Brain Injuries
3 most
common
types of • Intra parenchymal Hemorrhage
perinatal brain
injuries • Intra ventricular hemorrhage
(premies)
• Periventricular “leukomalacia”
(i.e., infarcts)

• Cerebral “Palsy”
refers to non-progressive diffuse cerebral
pathology apparent at childbirth
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 Various patterns of CNS injury in newborns

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 CNS TRAUMA
• Skull Fractures
• Parenchymal Injuries
• Traumatic Vascular Injury
• Sequelae
• Spinal Cord Trauma

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 BRAIN TRAUMA
• Contusion (bruise)
• Laceration (tear)
• Coup/Contre-Coup
• Concussion

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 Skull fracture types

“HAIRLINE” “DEPRESSED”,
aka
“DISPLACED”
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 HEMATOMAS/HEMORRHAGE
• EPIDURAL (fx)
• SUBDURAL (trauma No fx)
• SUBARACHNOID (arterial, no trauma)
• INTRAPARENCHYMAL (any)
• INTRAVENTRICULAR (no trauma, rare in
adults, common in premies)

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 EPIDURAL HEMATOMA

The ‘lucid’ interval is a classic feature of the epidural

hematoma

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 SUBDURAL HEMATOMA
No ‘lucid’ interval, but instead a sudden &
progressive worsening of symptoms
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SUBARACHNOID
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08/26/19 INTRAPARENCHYMAL
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Most are caused by rupture of a
small intraparenchymal vessel.
Hypertension is the most common

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INTRAPARENCHYMAL
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 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

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 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)

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 HYPERTENSIVE CVA
• Intracerebral
• Basal Ganglia Region
(lenticulostriate arteries of internal capsule,
putamen)

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 HYPERTENSIVE CVA

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 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)

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 CNS DEGENERATIVE DISEASES

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 THANK YOU
SELAMAT BELAJAR

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