P. 1
BMS - K36 Patologi Klinik - Kelainan CSF

BMS - K36 Patologi Klinik - Kelainan CSF

|Views: 3|Likes:
Dipublikasikan oleh Winson Chitra
PK
PK

More info:

Published by: Winson Chitra on Oct 12, 2013
Hak Cipta:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PPT, PDF, TXT or read online from Scribd
See more
See less

02/16/2015

pdf

text

original

BRAIN AND MIND SYSTEM

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

dgn rentang kadar yang sempit .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.

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

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

lumbar spinal area) .• Pelaksanaan LP utk pengambilan spesimen : . 2 dan 3.Ditaruh pada 3 tube sentrifus steril yg ditandai dgn no. 1. cisterna magna. Ca. Masing-masing 2-4 ml Spesimen tube 1. Glukosa bervariasi tergantung tempat spesimen diambil (ventricle. 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.Sebaiknya pagi hari dan jk dapat setelah puasa 1malam .Dilakukan pada dewasa : L3-L4 anak : L4-L5 .

like water Transparency : clear.006-1.008 Glucose : 45-100 mg/100ml (60-70% KGD) • Urea : 8-28 mg/100ml • Sodium : 117-137 mEq/L • Pottasium : 2.33-4.Composition of Normal Spinal Fluid • • • • • Amount : 90-150 ml Color : colorless.59 mEq/L . like water Specific Gravity : 1.

9 mEq/L • Uric acid : 0.31 – Pco2 : 47.9 mmHg – HCO3 : 22.2.8 mEq/L • Total protein : 20-40 mg/100ml – Lumbar : 20-40 mg/100ml – Cisternal : 15-25 mg/100ml – Ventricular : 5-10 mg/100ml .• Acid-base balance : – pH : 7.07.

mean values : – – – – – – Prealbumin Albumin α1-globulin α2.32 mEq/L Magnesium : 2.20 mEq/L Creatinine : 0.2 ± 2.globulin Β.and τ.0 % : 8.4 – 1.7 % • • • • • Calcium (lumbar) : 2.• Electrophoretic separation of lumbar fluid.5 % : 6.6 ± 13% : 49.5 ± 6.3 ± 2.1% : 18.5 mg/100ml Lactic dehydrogenase : 8-50 units Cell : 1-5 cells/mm3 (lymphocytes) .5 ± 4.7 ± 2.8 % : 11.globulin γ-globulin : 4.

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

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

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

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

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

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

small 20-100 PMN early. 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 Bloody yellow 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.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 .

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 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 .

small 20-100 PMN early. colorless Rare Rare Many. 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 .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. colorless 0 ± N N Filtrable virus Subarachnoid hemorrhage 1+ to 2+ Bloody yellow 0 Blood 3+ N N Neurosyphilis • Meningovascular • Tabes • Paresis + + + Clear.

You're Reading a Free Preview

Mengunduh
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->