BAB I PENDAHULUAN

I. 1 Skenario Seorang wanita berusia 40 tahun datang dengan keluhan utama sakit kepala kronis. Sejak 3 bulan SMRS pasien mengeluh sakit kepala berdenyut diseluruh kepala yang semakin memberat. Sakit kepala terutama timbul pagi hari. Terkadang disertai muntah tanpa didahului mual. Sakit kepala dirasakan memberat saat pasien mengedan buang air besar dan batuk I. 2 Kata Kunci a. Wanita,40 thn b. Nyeri kepala kronis, berdenyut c. Memberat d. Diseluruh kepala (bilateral) e. Disertai muntah f. Memberat saat mengedan & batuk I. 3 Pertanyaan 1. Struktur atau bangunan apa dari tubuh yang peka nyeri?
2. Bagaimana klasifikasi nyeri kepala?

BAB II PEMBAHASAN

II.1 Struktrur Peka Nyeri 1. Intrakranial Struktur-struktur intrakranial yang peka nyeri dan terlibat dalam nyeri kepala adalah:1
a. b.

Sinus venosus (sinus sagitalis) Arteri duramater (a. Meningea anterior dan media) Duramater dasar tengkorak N. V, N. IX, N. X Arteri yg membentuk sirkulus willisi dan cabang-2-nya Substansia grisea periaquaductal batang otak Nukleus sensoris dari talamus

c.
d. e.

f.
g.

Gambar 1. Cirkulus Willisi 2

Gambar 2. A.Meningea anterior (kiri). A. Meningea media (kanan) 2

Gambar 3. Sinus venosus intrakranial 3

Gambar 4. Nukleus sensoris dari thalamus 2

2. Ektrakranial Struktur-struktur ekstrakranial yang peka nyeri dan terlibat dalam nyeri kepala adalah: 1 a. Kulit, scalp, otot, tendon, dan fascia daerah kepala dan leher
b. Periosteum tengkorak terutama supra orbita, temporal dan oksipital

bawah c. Rongga orbita beserta isinya

d. Sinus paranasalis, oropharynx dan rongga hidung

e. Gigi geligi f. Telinga luar dan tengah g. Arteri ekstra kranial

h. Nervus C2 dan C3

Gambar 5. Struktur peka nyeri ekstrakranial 2,4,5

II.2 Klasifikasi Nyeri Kepala Klasifikasi nyeri kepala oleh International Headache Society (IHS) 6 1. Nyeri kepala primer a. Migraine Migraine without aura Migraine with aura Opthalmoplegic migraine Retinal migraine
Chil periodic syndromes that maybe precursors to or associated

with migraine Complications of migraine Migrainous disorder not fulfilling above criteria b. Tension-type headache Episodic tensic.r -type headache Chronic tension-type headache Headache of the tension-type not fulfilling above criteria
c. Cluster headache and chronic paroxysmal hemicrania

Cluster headache Chronic paroxysmal hemicrania Cluster headache-like disorder not fulfilling above criteria d. Miscellaneous headaches unassociated with structural lesion Idiopathic stabbing headache External compression headache Cold stimulus headache Benign cough headache Benign exertional headache Headache associated with sexual activity

2. Nyeri kepala sekunder a. Headache associated with head trauma Acute post-traumatic headache Chronic post-traumatic headache b. Headache associated with vascular disorders Acute ischemic cerebrovascular disorder Intracranial hematoma Subarachnoid hemorrhage Unruptured vascular malformation Arteritis Carotid or vertebral artery pain Venous thrombosis Arterial hypertension Headache associated with other vascular disorder c. Headache associated with nonvascular intracranial disorder Highcerebrospinalfluidpressure Low cerebrospinal fluid pressure Intracranial infection Intracranial sarcoidosis and other noninfectious inflamma tory diseases Headache related to intrathecal injections Intracranial neoplasm Headache associated with other intracranial disorder d. Headache associated with substances or their withdrawal Headache induced by acute sub stance use or exposure Headache induced by chronic substance use or exposure Headache from substance with drawal (acute use) Headache from substance with drawal (chronic use)

 Headache associated with sub stances but with uncertain mechanism e. Headache associated with noncephalic infection Viral infection Bacterial infection Headache related to other in fection f. Headache associated with metabolic disorder Hypoxia Hypercapnia Mixed hypoxia and hypercapnia Hypoglycemia Dialysis Headache related to other metabolic abnormality
g. Headache or facial pain associated with disorder of cranium,

neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures Cranial bone Neck Eyes Ears Nose and sinuses Teeth, jaws, and related structures Temporomandibular joint disease h. Cranial neuralgias, nerve trunk pain, and deafferentation pain Persistent (in Contrast to tic-like) pain of cranial nerve origin Trigeminal neuralgia Glossopharyngeal neuralgia Nervus intermedius neuralgia Superior laryngeal neuralgia

 Occipital neuralgia Central causes of head and facial pain other than tic douloureux
Facial pain not fulfilling criteria in groups 1 or 12

Daftar Pustaka
1. Price A.S, Wilson M.L. Patofisiologi konsep klinis proses-proses penyakit.

Ed-6. Vol 2 Jakarta: EGC; 2006

2. Penyunting Putz R, Pabst R. Sobotta atlas anatomi manusia [e-book]. Ed 22.

Jakarta: EGC; 2006.

3. Faiz O, Moffat D. Anatomy at a Glance [e-book]. England: Blackwell

Science ; 2002
4. Rizzo DC. Instructors manual for delmars fundamentals of anatomy and

physiology [e-book]. USA: Delmar ; 2001

5. Ellis H. Clinical anatomy arevision and applied anatomy for clinical

students [e-book]. 11st ed. India: Blackwell Publishing ; 2006

Laporan Individu Tutorial Blok Neuropsikiatri Desember 2011

Struktur Peka Nyeri dan Klasifikasi Tumor Intrakranial

(modul 1)

Nama NIM Tutor

: Diky Hardiyansyah : 09 777 019 : dr. Isnania, Sp.S dr. Magdalena, Sp.S

Kelompok : IV (empat)

PROGRAM STUDI PENDIDIKAN DOKTER UNIVERSITAS ALKHAIRAAT PALU 2011