Pathology of CNS

Neuropathology

Oleh:
Dr. Cahyono Kaelan, Ph.D, Sp.PA(K), Sp.S
 Topics
1.Introduction to Neuroanatomy
2.Neuronal Degeneration
3.Congenital Abnormality (Hydrocephalus)
4. Strokes (HS & NHS)
5. Infection ( Encephalitis, Meningitis)
6. CNS Tumors
7.Degenerative CNS Diseases (AD & PD)
The anatomy of the brain
CNS Cellular
• Neuron
• Astrocytes
• Oligodendroglia
• Microglia
• Ependym
NEURONAL DEGENERATION
 Neuronal Degeneration
• Chromatolysis:
is the dissolution of the
Nissl bodies in the cell
body of a neuron.

• Neurolysis:
the breaking down of
nervous tissue (as from
disease or injury)

• Neurophagia:
phagocytoses by
microglia
CONGENITAL ABNORMALITY
(HYDROCEPHALUS)
 Congenital Abnormality
(Hydrocephalus)

• Hydro = Water
• Cephalus = Head
• Infection within during pregnancy
• Disturbing of CSF circulation
STROKE
 Stroke

• HS = Hemorrhagic
stroke
• NHS = Non
Hemorrhagic
stroke
HS
• Umumnya
• Hipertensi,
• Aneurisma, Etiologi
• Malformasi HS
arteriovenosa
• Dll.

• EL-Mitwalli & Malkoff,

2001, :
• Hipertensi
• Alkohol
• Tingkat HDL
• Obat-obatan
 NHS
• Thrombus
• Emboli lepas akbt atrial fibrillasi, penyakit
jantung
• Atherosclerosis =Perkapuran p.darah
• DM
• Hyperlipidaemia
• Hypertensi
• Dyscrasia darah (gangguan darah)
 INFECTION
( ENCEPHALITIS, MENINGITIS)
 Infeksi ( Meningitis, Encephalitis )

• Radang selaput meninges

• M-Purulenta
• M-TBC
• Panas tinggi
• Kejang-kejang
• Kesadaran menurun
• Kaku kuduk
• Slide ( Praktikum Meningitis Purulenta)
TUMORS
 CNS Tumors
(Neoplasma sesuai asalnya)

• Astrocytoma
• Schwannoma
• Oligodendroglioma
• Ependymoma
• Choroid plexius papiloma
• Meningioma
klasifikasi
•Grade I: Pilocytic
•Grade II: Diffuse
•Grade III: Anaplastic
•Grade IV: Glioblastoma
 Astrositoma Grade 1
• Astrositoma
pilositic berupa
kistik dengan cairan
kuning kecoklatan
dan adanya nodul
mural (mural
nodule).
 • Sel

Meningioma:
• Pembungkus araknoid (arakhnoid cal cell)
• >> jinak, Meningioma Malligna jarang (1-
2% dari meningioma)
• Insidens 20%
• ♀>♂ tu > 60 thn
 Sign and symptom
• Slow growing, and may grow to a large size before
causing symptoms.
• The symptoms will depend on the location
• The first symptoms are usually due to increased
pressure on the brain caused by the growing tumor.
• Headache and weakness in an arm or leg are the most
common, although seizures, personality changes, or
visual problems may also occur.
• Pain and loss of sensation or weakness in the arms or
legs are the most common symptoms of spinal cord
meningioma.
• Most people with meningiomas will have no
symptoms.
 Tekanan intra kranial & Herniasi
Penyebab Peninggian TIK :
Brain edema, Tumor, Stroke (HS dan NHS),
Hydrocephalus, Trauma Perdarahan.
TIK meninggi  Herniasi (Penurunan bagian
otak ke bagian bawah / celah
• Herniasi  menekan batang otak   pusat
pernapasan dan Jantung Kematian
Herniation

Supratentorial herniation
1. Uncal (transtentorial)
2. Central
3. Cingulate (subfalcine)
4. Transcalvarial

Infratentorial herniation
5. Upward (upward cerebellar
or upward transtentorial)
6. Tonsillar (downward cerebellar)
 DEGENERATIVE DISEASE
(ALZHEIMER’S DISEASE DAN PARKINSON
DISEASE)
 Pathology
AD (Alzheimer’s Disease)
Atrofi lobus frontalis d temporalis
 Parkinson Disease
Gejala (TRAP)
• Tremor : resting tremor
• Rigidity : cogwheel
phenomena (gerakan pasif,
terputus2 dan langkah jalan
cepat tp pendek (festination)
• Akinesia: mask face, hipofonia,
drooling, mikrografia) dll
• Postural reflex terganggu: pull
test
Gejala tambahan
• motorik: freezing (bhenti
ditempat saat mau
melangkah, sdg berjalan),
start hesitation (ragu2
mulai melangkah), distonia
ddl
• Otonom: konstipasi,
impotensi seksual
• Mental: lambat berpikir,
depresi, dementia
• Lain-lain:
 Pathogenesis
• Degenerative (old), > 65 tahun
• Genetics
• Traumatic (repetitive injury / Pugulistic)
• Post infections (Encephalitis)
• Parkinsonism= Parkinson akibat obat2an
/psikotropika= usia muda (Bedakan dgn real
PD)
 Pathology PD

• Mid brain
• Kerusakan Subtantia Nigra
• Pigmented neuron
• Levy body
• Gliosis