5/14/2012

TatalaksanaMeningitisTB
Dr.DarmaImranSp.S(K)
DepNeurologiRSCMFKUI

Dr.DarmaImran,SpS

TTL
:Makassar,25April1967
INSTITUSI:DepartemenIlmuPenyakitSaraf

FKUI/RSCM
JABATAN:SPSProgramStudiIlmuPenyakit

SarafFKUI2008

KetuaSubbagianNeuroinfeksi
DepartemenNeurologiRSCM

AsistenManagerPenelitian&

PelatihanpadaUPTHIV/AIDS

FKUI/RSCM

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Topik
1. Lumbalpungsi
2. RegimenOATutkMeningitis

MeningitisTB(TBM)

TBM510%pasienTB
MortalitasMTBdiRSCM
NonHIV35%
HIV(+):60%

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HeinrichQuincke
Jerman18421922

Lumbalpungsiberulang
(drainase)pasienanakyg
komadandiagnosissbg
meningitisinfantum
PaskaLPkesadaranmembaik

Awal:LPditujukansebagai
terapi
1. QuinckeHI.Ueberhydrocephalus.VerhandlungdesCongressInnereMedizin
(X),1891;32139.
2. WynterWE.Fourcasesoftubercularmeningitisinwhichparacentesiswas
performedforthereliefoffluidpressure.Lancet1891;1:9812.

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LPHerniasi
Brainshiftlanjutherniasi
LPdapatmemicuherniasiotak

PerburukanklinispaskaLPtdkselalukarena
herniasi
HerniasipaskaLPtdkselalukarenaLP

Herniasi
1. Peningkatantekananintrakranial
2. Herniasiotak(brainshift)

Duakeadaanyangberbeda

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Brain
shift

Brainshiftpada
garistengah(falx
cerebri)

shiftkefossa
posteriordari
struktur
supratentorial

shiftkeatas
daristrukturdi
infratentorial

LPBrainShift
LPtdkdikerjakanpdbrainshift

LPdikerjakanpdTIKtinggi

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Mengenalbrainshift
Brainshift
padagaris
tengah(falx
cerebri)

shiftkeatas
daristrukturdi
infratentorial

TandaKlinis
Tandaimaging

shiftkefossa
posteriordari
struktur
supratentorial

Klinisbrainshift
Sefalgiadanmuntah
brainshifttentorium:kakukuduk,kesadaran
menurun,hemiparesis,pupilanisokor
Brainshiftforamenmagnum:kakukuduk,
headtilt,kesadaranmenurun,bradikardi,
apneu.

Papiledemawalaupunadabukanmerupakantandabrain
shift

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Brainshift

Suprasella

ambient
quadrigeminal
Normal

Shiftstruktur
infratentorialkeatas

JNNP1987;50:10711074

BahayaLP
LP:extremelyhelpfulandrarely
dangerous?(JNeurol(2002)249:129137)

Contraindicationstolumbarpunctureare
relativetotheimportanceofthedata
beingsought.(Neurology1993;43;625)

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RegimenOATutkMeningitisTB
TBmeningitisyangmemilikimortalitas3060
%:menggunakanOATyangsamadenganTB
paru.
ImmunepathologyberbedadgnTBparu
PenetrasiobatkeSSPberbedadgnjaringan
lain.

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PenetrasiOATpdSSP

PenetrasiOATpdSSP

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Patientsurvival(%)

RuslamidkkdiBandung:
DosisTinggiRifampisinpdMeningitisTB
100
80
60
40
20
0
0

50

100

150

200

days
SurvivalamongTBmeningitispatientstreatedwithhighdose()andstandarddose
()rifampicin(adjustedHR0.45,95%0.210.98).Onemonthmortalitywas
17%resp42%,sixmonthmortality34%resp61%.

Radiologicalfeatures:TBM

PaedInfectDisJ.2006;25(1):659

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5/14/2012

Terimakasih
darma_imran@yahoo.com

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