BRAIN AND MIND SYSTEM

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

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.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 .

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

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

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

33-4.59 mEq/L .006-1.008 Glucose : 45-100 mg/100ml (60-70% KGD) • Urea : 8-28 mg/100ml • Sodium : 117-137 mEq/L • Pottasium : 2. like water Transparency : clear.Composition of Normal Spinal Fluid • • • • • Amount : 90-150 ml Color : colorless. like water Specific Gravity : 1.

• Acid-base balance : – pH : 7.31 – Pco2 : 47.07.9 mmHg – HCO3 : 22.9 mEq/L • Uric acid : 0.8 mEq/L • Total protein : 20-40 mg/100ml – Lumbar : 20-40 mg/100ml – Cisternal : 15-25 mg/100ml – Ventricular : 5-10 mg/100ml .2.

globulin γ-globulin : 4.20 mEq/L Creatinine : 0.8 % : 11.0 % : 8.5 ± 6.• Electrophoretic separation of lumbar fluid.5 mg/100ml Lactic dehydrogenase : 8-50 units Cell : 1-5 cells/mm3 (lymphocytes) .5 ± 4.5 % : 6.2 ± 2.4 – 1.3 ± 2.6 ± 13% : 49.7 % • • • • • Calcium (lumbar) : 2. mean values : – – – – – – Prealbumin Albumin α1-globulin α2.32 mEq/L Magnesium : 2.7 ± 2.and τ.1% : 18.globulin Β.

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

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

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

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

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

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

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 .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.

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 .

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