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. dgn rentang kadar yang sempit . 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.

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

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

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

like water Transparency : clear.008 Glucose : 45-100 mg/100ml (60-70% KGD) • Urea : 8-28 mg/100ml • Sodium : 117-137 mEq/L • Pottasium : 2.33-4. like water Specific Gravity : 1.006-1.Composition of Normal Spinal Fluid • • • • • Amount : 90-150 ml Color : colorless.59 mEq/L .

07.• Acid-base balance : – pH : 7.31 – Pco2 : 47.9 mEq/L • Uric acid : 0.2.9 mmHg – HCO3 : 22.8 mEq/L • Total protein : 20-40 mg/100ml – Lumbar : 20-40 mg/100ml – Cisternal : 15-25 mg/100ml – Ventricular : 5-10 mg/100ml .

1% : 18.20 mEq/L Creatinine : 0.8 % : 11.7 ± 2.and τ.5 ± 6.3 ± 2.globulin γ-globulin : 4. mean values : – – – – – – Prealbumin Albumin α1-globulin α2.4 – 1.5 % : 6.0 % : 8.• Electrophoretic separation of lumbar fluid.6 ± 13% : 49.5 ± 4.7 % • • • • • Calcium (lumbar) : 2.32 mEq/L Magnesium : 2.5 mg/100ml Lactic dehydrogenase : 8-50 units Cell : 1-5 cells/mm3 (lymphocytes) .2 ± 2.globulin Β.

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

bisa terlihat clot * Pada intracerebral hemorrage bisa terlihat jernih Xanthochromia : • .Bloody tap (traumatic tap) : * Cedera pbl darah pada tindakan LP * Tube 1. 3 berturut-turut jlh darah makin kurang * Jk ragu.Hemorrhage : * Darah pada tube 1. 2. 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 . tidak berwarna Darah : .merah * gross  abaikan pem.2 dan 3 sama banyak * Supernatan kekuningan * Eritrosit crenated * Jk darah banyak. tak berwarna .Makroskopis • • Jernih.

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

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

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

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

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. colorless Bloody yellow Clear. 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 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. lymphocytes leter 25-75 lymphocytes 25-50 lymphocytes + to 2+ + + N N N N N N .

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. 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. small 20-100 PMN early. colorless Rare Rare Many.

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