Calvaria
a. Atap (vault) beserta fungsi
os frontalis motorik, emosi, ekspresi
temporal memori
occipital vision
parietal sensorik
Basis (os frontal, temporal, occipital, sphenoid)
b. Lapisan SCALP
Skin, connective tissue (subkutis), aponeurotik galea,
loose connective tissue, periosteum
Cedera kepala
-
Perdarahan intrakranial/intraserebral
IVH-intraventrikular hemorage
Pneumocephalus intracranial pneumatocele, a
collection of gas within the skull
Kebocoran csf : otorrhea (bocornya csf dari kanal
auditorik eksternal), rhinorrhea (keluarnya cairan
spinalis dari hidung disebabkan o/ trauma pd
lempeng cribiform)
Kejang/epilepsi
Anemia, hipotensi, syok
Infeksi : bl # bassis cranii ks ab profilaksis
Dehidrasi/overhidrasi
Cedera otak
1.
2.
3.
4.
5.
6.
7.
Klasifikasi klinis
Coma
-
Indikasi MRS
-
Pupil anisokor
Kapan dirujuk
-
Indikasi CT scan
-
GCS < 9
GCS menurun 2 poin
GCS 9-13 > 2 jam
Nyeri kepala, vertigo, mual, muntah yg persisten
Ada lateralisasi
Ada gejala defisit neurologis focal
Ada atau curiga fraktur tulang kepala
Luka tusuk jelas atau dicurigai
Umur > 50 th
Evaluasi post op
Faktor ekstrakranial
Faktor intrakranial
-
Autoregulasi otak
-
Komplikasi lambat
-
Intracranial pressure
-
10 mmHg = normal
>20 mmHg = abnormal
>40 mmHg = severe
Many pathologic processes affect outcome
ICP brain function, outcome
Acute Complication
-
Infeksi
Dementia
Hidrosefalus
In adults the commonest cause of hydrocephalus
is an interruption of the normal CSF absorption
through the arachnoid granulations. This occurs
when blood enters the subarachnoid space after
subarachnoid hemorrhage, passes over the
brain, and interferes with normal CSF absorption.
To prevent severe hydrocephalus it may be
necessary to place a small catheter through the
brain into the ventricular system to relieve the
pressure.
Epilepsi
Post concussion syndrome = traumatic brain
injury
Injury akibat direct injury + gangguan mental
status atau kesadaran
Post traumatic cerebral syndrome
Hal-hal khusus
-
Trepanasi , kraniotomi
Dehidrasi
Lapar
Psikosa SOO
Analgetik parasetamol
Dead : D
Persisitent vegetative stage (PVS) : has no
obvious cortical functioning
Severe disability (SD) : concious but dependent
Moderate disability (MD) : independent but
disable/not of returning to full-time employment
Good recovery : excellent, may have no
disabling sequele, reintegrated, independent
Rangkuman
-
Bila px sadar
Tambahan
-
ABC
Euvolemia
Cegah cedera sekunder
CT scan stl resusitasi
Segera konsultasi dan transfer stl ekstrakranial
stabil
Ulang serial pemeriksaan status neurologis
Membaca CT scan
-
Identitas
SCALP
Tulang ap ad fraktur? Jenis fraktur
Intrakranial
Fokal lesi
Sulkus gyrus
Cysternus [U]
Ventrikel [)(]
Contoh
1. Identitas
Gst md septi ariawan
Px laki-laki, 18 th, MRS : 13 Juli 2011 (sdh __ hr),
dtg tdk sadar stl mengalami kecelakaan terjatuh
sendiri dr spd motor k arah kanan 2 jam
SMRS. Px tdk memakai helm. Riwayat sadar (+)
selama __ menit, amnesia (_), muntah (_), mual
(_)
GCS saat datang E2V2M5
2. Telah dilakukan CT scan pd tgl___, didapatkan
hasil :
Intrakranial
Fokal lesi terdapat fokal lesi
hiperdense berbentuk bikonvex pada
regio temporoparietal (D)
Sulkus gyrus tidak tampak jelas
Cysternus [U] tdk mengalami
penyempitan
Ventrikel [)(] tdk mengalami
penyempitan
Midline shift [|] sejauh 8 mm ke arah (S)
3. Kesan :
4.
5.
Etc
Dx
Etc
Pd px telah dilakukan trepanasi pd tgl___, skr
hari ke-
6.
Tambahan
Syok Neurogenik, TD turun, HR turun
Syok Hipovolemik TD turun, HR naik
Syok Spinal Hemodinamik stabil