Fisiologi

Salsabila Firdausia
1710211046
Lobus Otak
Lobus Frontal
 terletak di bagian depan otak.
Lobus Parietalis
 Fungsinya adalah menerima dan memproses
somatosensorik (sensasi sentuhan seperti tekanan, nyeri,
panas, dingin) dan propiosepsi
Lobus Temporal
 terletak di kedua sisi kepala sejajar dgn telinga. Hal ini terutama
terlibat dalam memproses dan menafsirkan suara. Pada lobus
temporal juga terdapat hippocampus, yang memproses
pembentukan memori
Lobus Oksipital
 terletak di otak bagian belakang. Berfungsi untuk
mengenali dan mengidentifikasi dunia visual.
Rongga intrakranial
 terdiri dari cairan serebrospinal, darah, dan jaringan otak
 TIK adalah tekanan yang dihasilkan dari kombinasi volume 3
komponen. Yaitu volume jaringan otak, volume darah
intrakranial dan cairan serebrospinal.
 TIK normal bervariasi antara 0 – 15 mmHg.
Monro kellie

 the Monro–Kellie hypothesis states that the cranial compartment is

inelastic and that the volume inside the cranium is fixed. The cranium
and its constituents (blood, CSF, and brain tissue) create a state of
volume equilibrium, such that any increase in volume of one of the
cranial constituents must be compensated by a decrease in volume of
another
 These buffers respond to increases in volume of the remaining
intracranial constituents. For example, an increase in lesion volume (e.g.,
epidural hematoma) will be compensated by the downward
displacement of CSF and venous blood. Thus, very early after injury, a
mass such as a blood clot can enlarge while the ICP remains normal.
However, once the limit of displacement of CSF and intravascular blood
has been reached, ICP rapidly increases.
 (Top) in the normal state, 80% is filled by
brain; 10% by CSF and 10% by blood.
 (2nd Row) when a mass in present,
initially the volume of CSF decreases to
compensate.
 (Third Row) if the mass enlarges, not
only must the volume of CSF decrease,
but also the blood volume (venous
blood first).
 (Bottom Row) if the mass continues to
expand, the blood volume will be
reduced further resulting in brain
ischemia and brain death
Normal Rate of Cerebral Blood Flow

 Brain: 1350 gm; 2% of Total Body Weight

 Normal blood flow through the brain of the adult person
averages 50 to 65 ml/ per 100 grams of brain tissue per
minute.
 For entire brain: 750 to 900 ml/min
 Cerebral blood flow depends on cerebral perfusion
pressure, which is defined as the mean arterial pressure
minus the intracranial pressure (CPP = MAP – ICP).
Therefore, as the intracranial pressure increases, cerebral
perfusion pressure decreases
Autoregulasi Serebral
 autoregulasi cerebral ialah kemampuan otak
mempertahankan CBF dalam batas-batas normal dalam
menghadapi tekanan perfusi cerebral(CPP) yang berubah.
 Biasanya autoregulasi akan dapat mempertahankan CBF
selama MAP antara 50-150 mmHg.

CPP = MAP - ICP

 MAP: mean arterial pressure
 ICP: intracranial pressure (5-12 mmHg)
Fig. 1. Cerebral autoreglation in relation to vascular response. Within the upper and
lower boundaries of the autoregulatory range blood flow remains constant .As Pressure
falls below the lower limit, vascular smooth muscle relaxes to allow dilatation, while
constriction of vessels (red circles) ensues to reduce blood flow as pressure
approximates the upper limit. Adapted from Pires et al., 2013.
Mekanisme myogenik

 Arterioles dilate or constrict in response to changes in BP and ICP in

order to maintain a constant CBF
 The vascular smooth muscles are highly responsive to changes in
pressure, a process called myogenic activity
 Vascular smooth muscle within cerebral arterioles contract to stretch
response, regulating pressure changes.
Mekanisme metabolik

 Three metabolic factors have potent effects

in controlling the cerebral blood flow.
cerebral blood flow:
(1) Carbon dioxide concentration,
(2) Hydrogen ion concentration,
(3) Oxygen concentration.
Konsentrasi karbon dioksida
 increase Carbon dioxide (Hypercapnia) causes cerebral
vasodilation.
 When it is decreased vasoconstriction is induced.
Konsentrasi ion Hidrogen
 Carbon dioxide is increase cerebral blood flow by
combining with water in the body fluids to form carbonic
acid, with subsequent dissociation of this acid to form
hydrogen ions.
 The hydrogen ions cause vasodilation of the cerebral
vessels. The dilation directly proportional to the increase in
hydrogen ion concentration.Increases Hydrogen ion
concentration, increase CBF .
 Increased hydrogen ion depresses neuronal activity. It is
fortunate that an increase in hydrogen ion concentration
also causes an increase in blood flow, which in turn
carries hydrogen ions, carbon dioxide, and other acid
forming substances away from the brain tissues.Loss of
carbon dioxide removes carbonic acid from the tissues;
this, along with removal of other acids, reduces the
hydrogen ion concentration back toward normal. Thus,
this mechanism helps maintain a constant hydrogen ion
concentration in the cerebral fluids and thereby helps to
maintain a normal, constant level of neuronal activity
Konsentrasi oksigen
 Decrease in cerebral tissue PO2
below about 30 mm Hg (normal
value is 35 to 40 mmHg) immediately
begins to increase cerebral blood
flow.
 Brain function becomes unbalanced
at lower values of PO2, at PO2 levels
below 20 mm Hg.
 Oxygen mechanism for local
regulation of cerebral blood flow is
important protective response
against diminished cerebral neuronal
activity
Mekanisme neurogenik
 vasokonstriksi mikrovaskular terjadi karena depolarisasi
interneuronal. Neuron-neuron menghasilkan neurotransmiter
berbeda yang memiliki efek vasoaktif, seperti asetilkolin atau
nitrit oksida yang dapat menyebabkan vasodilatasi, dan
serotonin serta neuropeptida Y yang dapat menstimulasi
vasokonstriksi.
 The sympathetic nervous system normally constricts the large
and intermediate-sized brain arteries enough to prevent the
high pressure from reaching the smaller brain blood
vessels.This is important in preventing vascular hemorrhages