BRAIN AND MIND SYSTEM

KELAINAN CAIRAN OTAK
Dept. Patologi Klinik FK USU dr. Tapisari Tambunan SpPK (K) dr. Ozar Sanuddin SpPK (K)

Physiology * Cerebrospinal fluid (CSF) : * merupakan produk aktifitas ventricular choroid plexuses * bersirkulasi melalui ventricles dan subarachnoid spaces * diabsorbsi oleh arachnoid villi  venous sinuses  aliran darah * fungsi utama : proteksi. memberi bantalan untuk brain dan spinal * Blood Brain Barrier bekerja dgn proses metabolik aktif menjaga kons sbgn besar substansi dlm CSF dlm kadar yg berbeda dari dlm darah. dgn rentang kadar yang sempit .

Treatment pada bbrp pasien dgn hipertensi intracranial benigna • Komplikasi LP: .Suspek Meningitis. obat-obat . Encephalitis. Brain abscess.Pemberian anestesi.DD cerebral infark dgn cerebral hemorrhage (80%) . media kontras. subarachnoid hemorrage .Pengambilan spesimen untuk pemeriksaan • Biasanya dgn Lumbal punksi • Indikasi LP: .

Perforasi meninges (pd kasus sepsis) .Herniasi.Postpuncture headache • Pelaksanaan LP: . mortalitas meningkat (pd tek.Paresis sampai paralisis (pd spinal cord tumor) . Intracranial tinggi) .Infeksi ( tidak aseptik) . obst trachea) .• Komplikasi LP: .Extradural @ Subdural hematoma (pd gangguan pembekuan darah) .Kematian pada bayi jk tindakan berlebihan (aspiksia.

Glukosa bervariasi tergantung tempat spesimen diambil (ventricle. cisterna magna. Masing-masing 2-4 ml Spesimen tube 1.Sebaiknya pagi hari dan jk dapat setelah puasa 1malam . biasanya tdk digunakan karena dapat bercampur darah dari trauma punksi Spesimen tube 2 : utk sel & hitung jenis dan pemeriksaan kimia atau imunologi Spesimen tube 3 : kultur • Kadar Protein.Dilakukan pada dewasa : L3-L4 anak : L4-L5 . Ca.• Pelaksanaan LP utk pengambilan spesimen : .Ditaruh pada 3 tube sentrifus steril yg ditandai dgn no. 1. lumbar spinal area) . 2 dan 3.

33-4.008 Glucose : 45-100 mg/100ml (60-70% KGD) • Urea : 8-28 mg/100ml • Sodium : 117-137 mEq/L • Pottasium : 2.Composition of Normal Spinal Fluid • • • • • Amount : 90-150 ml Color : colorless. like water Specific Gravity : 1.59 mEq/L .006-1. like water Transparency : clear.

2.8 mEq/L • Total protein : 20-40 mg/100ml – Lumbar : 20-40 mg/100ml – Cisternal : 15-25 mg/100ml – Ventricular : 5-10 mg/100ml .9 mmHg – HCO3 : 22.9 mEq/L • Uric acid : 0.07.31 – Pco2 : 47.• Acid-base balance : – pH : 7.

5 ± 6.5 % : 6.2 ± 2.5 ± 4.5 mg/100ml Lactic dehydrogenase : 8-50 units Cell : 1-5 cells/mm3 (lymphocytes) .globulin γ-globulin : 4.3 ± 2.4 – 1.6 ± 13% : 49. mean values : – – – – – – Prealbumin Albumin α1-globulin α2.32 mEq/L Magnesium : 2.8 % : 11.0 % : 8.7 ± 2.and τ.20 mEq/L Creatinine : 0.globulin Β.1% : 18.7 % • • • • • Calcium (lumbar) : 2.• Electrophoretic separation of lumbar fluid.

Pemeriksaan Lab • • • • • Makroskopis Mikroskopis Analisa Kimia Imunologi Mikrobiologi .

tidak berwarna Darah : . Kimia * koreksi perhitungan lekosit : jlh lekosit = jlh leko terhitung – a a = jlh eri dlm darah x leko dlm darah jlh eri dlm CSF . 2.Bloody tap (traumatic tap) : * Cedera pbl darah pada tindakan LP * Tube 1. bandingkan hitung sel tube 1 dan ke 3 * Supernatan setelah disentrifus : jernih.Makroskopis • • Jernih. 3 berturut-turut jlh darah makin kurang * Jk ragu.merah * gross  abaikan pem.Hemorrhage : * Darah pada tube 1. bisa terlihat clot * Pada intracerebral hemorrage bisa terlihat jernih Xanthochromia : • . tak berwarna .2 dan 3 sama banyak * Supernatan kekuningan * Eritrosit crenated * Jk darah banyak.

acute meningitis : bervariasi berawan s/d spt pus . tuberculous meningitis : jernih • Sedimen : Normal tdk ada • Clot : adanya fibrinogen .> 200 lekosit : cloudy 200 – 500 lekosit : keruh > 500 : turbid . @ prematur).Jk mengandung banyak protein dan clot. lipidlike substance karena destruksi jar. mis. tumor • Transparansi : . otak .encephalitis. indikasi adanya obstruksi.Kekuningan .• Xanthochromia : . derivat Hb. kronis.Bisa warna bilirubin (jk jaundice berat.

Syphilic . masa dini (1-2 hari) viral. jamur . alergi . TB. TB.Mikroskopis • Diperiksa pada sedimen • Total lekosit normal .plasma sel meninggi : multiple sclerosis . jamur.netrofil tinggi : infeksi bakteri.eosinofil meninggi : non infeksi : vaksinasi rabies.limfosit meninggi : Viral.dewasa : 0 .neonati : 0 – 30 • Eritrosit : bedakan dulu trauma atau tidak • Hitung jenis : .6 mononuclear /mm3 .

jar.Prognose encephalitis :jelek jk LDH tinggi .Kimia Klinik • Total Protein • Glukosa : Normal : 60 – 70 % KGD (seimbang 2-4 jam) Meninggi : hiperglikemia Menurun : .hipoglikemia . eritrosit.DD bacterial @ viral meningitis .normal 5 – 10 % kadar plasma . mo .gangguan transport dari plasma ke CSF • LDH : . lekosit.pemakaian meningkat oleh CNS.

Lain-lain • Serologis : sifilis. FTA (fluorescent treponemal antibody • Elektrolit • Mikrobiologi . VDRL.

small 20-100 PMN early. colorless Bloody yellow Clear.Cerebrospinal fluid in disease Disease Preasure (mm water) 100-200 Appearance Clot No & Type of Cell Protein (mg/100ml) 20-40 Sugar (mg/1 00ml) 45-100 Chlorides (mEq/L) 113-127 Remarks Normal Meningitis • Pyogenic • Tuberculous • Lymphocytic choroimeningitis Cord Tumor Brain Abscess Brain Tumor Poliomyelitis Clear. lymphocytes leter 25-75 lymphocytes 25-50 lymphocytes + to 2+ + + N N N N N N . colorless Cloudy Clear or slightly turbid Clear or opalescent 0 0-5 lymphocytes 3+ 3+ 2+ Large Web 0 3+ PMN 2+ lymphocytes 50-2000 lymphocytes 3+ 2+ + D(0) 20-40 20-40 Slightly D D<100 N Tubercle bacilli N 1+ to 3+ 3+ N Clear & deep yellow Clear or turbid Clear yellow Clear or opalescent Mass ± ± 0 N to + lymphocytes + PMN N lymphocytes 50-2000 PMN early lymphocytes leter N to + lymphocytes 3+ + to 2+ ± to 2+ + N N N N N N to slightly D N N to slightly D Filtrable virus Encephalitis N to Clear. colorless 0 ± N N Filtrable virus Subarachnoid hemorrhage Neurosyphilis • Meningovascular • Tabes • Paresis 1+ to 2+ 0 Blood 3+ N N Serologic test for syphilis nearly always reactive 80% reactive 100% reactive + + + Rare Rare Many.

colorless 0 0-5 lymphocytes 20-40 45-100 113-127 Meningitis • Pyogenic • Tuberculous • Lymphocytic choroimeningitis 3+ 3+ 2+ Cloudy Clear or slightly turbid Clear or opalescent Large Web 0 3+ PMN 2+ lymphocytes 50-2000 lymphocytes 3+ 2+ + D(0) 20-40 20-40 Slightly D D<100 N Tubercle bacilli Cord Tumor N Clear & deep yellow Mass N to + lymphocytes 3+ N N Brain Abscess 1+ to 3+ Clear or turbid ± + PMN + to 2+ N N to slightly D Brain Tumor 3+ Clear yellow ± N lymphocytes ± to 2+ N N .Cerebrospinal fluid in disease Disease Preasure (mm water) Appearance Clot No & Type of Cell Protein (mg/100ml) Sugar (mg/1 00ml) Chlorides (mEq/L) Remarks Normal 100-200 Clear.

colorless 0 ± N N Filtrable virus Subarachnoid hemorrhage 1+ to 2+ Bloody yellow 0 Blood 3+ N N Neurosyphilis • Meningovascular • Tabes • Paresis + + + Clear. small 20-100 PMN early. lymphocytes leter 25-75 lymphocytes 25-50 lymphocytes + to 2+ + + N N N N N N Serologic test for syphilis nearly always reactive 80% reactive 100% reactive . colorless Rare Rare Many.Cerebrospinal fluid in disease Disease Preasure (mm water) Appearance Clot No & Type of Cell Protein (mg/100ml ) Sugar (mg/100ml) Chlorides (mEq/L) Remarks Poliomyelitis N Clear or opalescent 0 50-2000 PMN early lymphocytes leter N to + lymphocytes + N N to slightly D Filtrable virus Encephalitis N to Clear.

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