8. Neuroimaging Isti
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NEUROIMAGINGNEUROIMAGING
dr. Noflih Sulistia
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ANATOMIANATOMI
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ANATOMIANATOMI
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ANATOMIANATOMI
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ANATOMIANATOMI
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ANATOMI
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ANATOMIANATOMI
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VASKULARISASIVASKULARISASI
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KELAINAN - KELAINANKELAINAN - KELAINAN
TRAUMA INFEKSI TUMOR STROKE
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Trauma tumpul ◦Deformitas otak sekitar ◦ Acelerasi tulang kepala
Jaringan otak tertekan pada lokasi yang terkena (‘coup’) dan terjadi distensi pada sisi yang berlawanan (‘contra coup’)
TRAUMA KEPALATRAUMA KEPALA
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A. Cedera pada scalpB. Cedera calvariaC. Kelainan extra-aksial :
* SAH* SDH* EDH* Subdural hygroma* Perdarahan intravent.* Pneumocephalus
D. Kelainan intra-aksial :* Edema cerebral* Contusio / hematome intraparenkim* DAI / shearing injury* Post traumatic infarction* Brainstem injury
E. Herniasi otakF. Sequelae post traumaG. Luka tembak / projectile
injuries
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MANIFESTASI TRAUMA MANIFESTASI TRAUMA CRANIOCEREBRALCRANIOCEREBRAL
SCALP :1. Caput succedaneum 2. Subgaleal hematome3. Cephalo hematome
CALVARIA :Kegunaan scout view :a. Frakturb. Corpus alienumc. Cervical bag. atas
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FRAKTUR OSSA CRANIUMFRAKTUR OSSA CRANIUM
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FRAKTUR LINIER – FRAKTUR DEPRESEDFRAKTUR LINIER – FRAKTUR DEPRESED
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FRAKTUR DIASTASISFRAKTUR DIASTASIS
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Epidural Hematom (EDH) Epidural Hematom (EDH)
Perdarahan pada arteri meningeal media atau salah satu cabangnya
Perdarahan pada vena di dalam granulatio pacchioni/sinus Fossa posterior
Mengenai pada tabula interna tulang calvaria
Paling banyak mengenai temporoparietal
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EDHEDH
Pada fossa cranialis posterior sangat berbahaya dan memberi gejala yang tiba-tiba
Darah mengangkat duramater dari calvaria
Gejala klinis akut dan memberikan kompresi cerebri yang cepat tindakan bedah
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EDHEDH
Gambaran CT :◦Lesi hiperdens dengan permukaan bikonveks yang mengisi konkavitas calvariaBatas tegasTerlihat adanya ‘mass effect’Kronis ‘mixed density area’
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Subdural Hematoma (SDH)Subdural Hematoma (SDH)
Avulsi vena pontineTerbukanya granulatio pacchioniTerlukanya pembuluh darah pia
materPerdarahan contusio cerebri
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SDHSDH
Hematom meluas melewati ruang subdural mengenai gyrus mayor hemisfer cerebri dan menekan otak
Mengenai seluruh umur, sering dekade VI – VII
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SDHSDH
Terdiri dari :◦Acute Subdural Hematoma (ASDH)◦Chronic Subdural Hematoma◦Subdural Hygroma
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Acute Subdural HematomaAcute Subdural Hematoma
Setelah beberapa jam sampai 2 hari post trauma
Biasanya diikuti dengan edema cerebri ipsi lateral
Gambaran CT :◦Lesi hiperdens yang mengisi konkavitas calvaria
dengan permukaan datar/berbentuk crescent (bulan sabit)
◦Pergeseran struktur garis tengah◦Bila menyumbat Foramen Monro dilatasi ventrikel
lateralis
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ASDHASDH
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ASDHASDH
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Chronic Subdural HematomaChronic Subdural Hematoma
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Subdural HygromaSubdural Hygroma
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EDH vs. SDHEDH vs. SDH
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SUB ARACHNOID BLEEDINGSUB ARACHNOID BLEEDING
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Perdarahan Subarachnoid (SAB)Perdarahan Subarachnoid (SAB)
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Perdarahan IntraventrikulerPerdarahan Intraventrikuler
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Herniasi CerebriHerniasi Cerebri
Masalah yang menjadi ancaman kehidupan pasien ‘herniasi cerebri’◦Lesi supratentorial menyebabkan transfalcine herniasi (subfalxi/falx cerebri herniasi)
CT : - pergeseran struktur garis tengah - obliterasi subarachnoid space
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◦Transtentorial herniationDisini otak supra tentorial terutama gyrus lobus temporalis medial bawah (gyrus hypocampus dan uncus) bergeser ke inferior melalui tentorial notchCT : terjadi pendesakan brain stem atau
obliterasi sisterna ambient◦Herniasi tonsil cerebelli Melalui foramen magnum dan menekan medulla
oblongata, biasanya tidak terlihat pada CT, tetapi jelas pada MRI
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HERNIASI OTAKHERNIASI OTAK
1. Subfalcial2. Uncal3. Downward4. External5. Tonsillar6. Upward
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STROKESTROKE
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StrokeStroke
Penyakit yang terjadi akibat terganggunya aliran darah ke otak secara tiba-tiba sehingga menyebabkan kerusakan neurologis
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StrokeStroke
Tipe oklusif/penyumbatan (stroke iskemik)◦Stroke yang disebabkan karena adanya penyumbatan
pembuluh darah
Tipe hemoragi/perdarahan (stroke hemorragik)◦Stroke yang disebabkan karena perdarahan
intrakranial
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StrokeStroke
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Stroke IskemikStroke Iskemik
Adanya aterotrombosis atau emboli memutuskan aliran darah otak(cerebral blood flow/CBF)
Nilai normal CBF = 53 ml/100 mg jaringan otak/menit
Jika CBF < 30 ml/100 mg/menit iskemik
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Stroke IskemikStroke Iskemik
Penyebab:EmboliAtherosklerosis pada
arteri otak (pembentukanplak/deposisi lemakpada pembuluh darah)
Hiperkoagulabilitasdarah, peningkatan kadar platelet, trombosis
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Stroke HemorragikStroke Hemorragik
Hemoragi merupakan penyebab ketiga tersering serangan stroke
Penyebab utamanya: hipertensi terjadi jika tekanan darah meningkat dengan signifikan pembuluh arteri robek perdarahan pada jaringan otak membentuk suatu massa jaringan otak terdesak, bergeser, atau tertekan(displacement of brain tissue) fungsi otak terganggu
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Stroke HemorragikStroke Hemorragik
Semakin besar hemoragi yg terjadi semakin besar displacement jaringan otak yang terjadi
Pasien dengan stroke hemoragik sebagian besar mengalami ketidaksadaran meninggal
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Gejala dan TandaGejala dan Tanda
Pada stroke hemoragik :Onset manifestasi kliniknya cepat gejala fisik
neurologis yang muncul tergantung pada tempat perdarahan dan besarnya perdarahan mayoritas pasien kehilangan kesadaran, dan banyak yang akhirnya meninggal tanpa sempat sadar lagi sebelum pingsan, pasien umumnya akan mengalami sakit kepala dan dizziness
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Stroke Hemorragik - PISStroke Hemorragik - PIS
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PISPIS
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PISPIS
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LATIHAN EXPERTISELATIHAN EXPERTISE
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EDHEDH
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EDHEDH
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EDHEDH
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EDHEDH
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ASDHASDH
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ASDHASDH
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ASDHASDH
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Subdural HygromaSubdural Hygroma
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Chronic Subdural HematomaChronic Subdural Hematoma
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SEMOGA BERMANFAAT