PERDARAHAN INTRAKRANIAL

Oleh : Salsalina Violetha Br Ginting

TRAUMA KEPALA
• Epidural hematoma
Interval lucid (talk and die)
robeknya a.meningeal media
Pupil anisokor
• Subdural hematoma
Hemiparesis dan penurunan kesadaran, cephalgia.
Robeknya bridging vein.
• Subarachnoid hemorrhage (stroke)
Thunderclap headache, tanda meningeal, Penurunan kesadaran –
 Etiologi: robeknya aneurysma
• Intracerebral hemorrhage (stroke)
Paresis, hypesthesia, ataxia, penurunan kesadaran
 Etiology: Hypertension
Coup-countercoup
injury
Epidural Hematome

Perdarahan extradural diantara periosteum

calvaria dengan duramater.
• Ruptur a. meningea media cabang a. maxillaris
• Terjadi pada daerah temporal (bagian mobile)
• Lebih sering akibat coup
• Gejala : ditemukan lucid interval (talk and die)
• Radiologis : Biconvex/lenticular shape
Epidural hematoma is located between the skull and dura mater

Interval lucid (talk and die)

Subdural Hematome

Perdarahan diantara duramater dan arachnoid mater.

• Ruptur dari bridging vein
• Terjadi pada daerah temporo-occipital
• Lebih sering akibat counter coup
• Gejala : perlahan-lahan menurun kesadaran
• Radiologis : semilunar shape
 Subdural Hematoma.
Axial CT scan demonstrates a
left parietal subdural hematoma
hyperdense to the brain (white
arrows). There is associated mass
effect with effacement of the left
lateral ventricle and shift of the
midline to the right (red arrows).
 Subdural Hematoma.
Image on left at brain
windows shows a slight
increase in density,
crescentric in shape, along
the inner table of the left
cranial vault (red arrows)
with a shift of the midline
structures (white arrow)
indicating mass effect. The
subdural window on the
right clearly shows the high
density crescent-shaped
blood concave toward the
cerebral hemisphere (yellow
arrows).
Subarachnoid Hemmorhage
Perdarahan diantara arachnoid mater
dan piamater
• Ruptur dari arteri biasanya akibat
pecahnya aneurima dan AVM
• Terjadi pada daerah batang otak,
biasanya pada cabang arteria basilaris.
• Gejala : thunderclap headache,
mimik gejala stroke hemorrhagik,
meningeal sign (+)
• Radiologis : Filling the sulci, biasanya
diikuti adanya IVH
Subarachnoid hemorrhage (SAH).
There is high-attenuation blood in
the Sylvian fissures (blue arrows)
and the interhemispheric fissure
(red arrow) seen on this non-
contrast enhanced CT of the brain.
Do not confuse normal, physiologic
calcifications (white and black
arrows) for blood
Intracerebral Hemmorhage

Perdarahan pada parenkim otak

• Biasanya pada stroke
hemorrhagik
• Hemorrhage occurs in about
15% of strokes
• About 60% of hypertensive
hemorrhages occur in the basal
ganglia
Intracerebral hemorrhage, acute.
Freshly extravasated whole blood, as this
bleed into the thalamus (thin white arrow)
will be visible as increased density on non-
enhanced CT scans of the brain due
primarily to the protein in the blood (mostly
hemoglobin). As the clot begins to form, the
blood becomes denser for about 3 days
because of dehydration of the clot. After the
3rd day, the clot gradually decreases in
density from the outside in and becomes
invisible over the next several weeks.
Fraktur
Kranium
Fraktur Linear  Fraktur dengan bentuk garis tunggal/stellata pada
tulang tengkorak, mengenai seluruh ketebalan tulang kepala
Fraktur Diastasis Fraktur yang terjadi pada sutura tulang tengkorak
yang mengakibatkan pelebaran sutura
Fraktur Kominutif  Fraktur lebih dari 1 fragmen tulang dalam satu
area fraktur
Fraktur Kompresi disertai fragmen patahan tulang terdorong ke dalam
 Dianggap bermakna bila segmen tabula eksterna yang impresi
masuk di bawah segmen tabula interna tulang yang sehat (>1 diploe)
Perlu dilakukan CT Scan  menentukan dalamnya penekanan,
menyingkirkan adanya hematoma intracranial/kontusio
Indikasi operasi : Fraktur impresi >1 diploea, terdapat lesi intrakanial
dibawah segmen, terdapat deficit neurologis
TERIMA KASIH