SARAF PUSAT
Oleh :
Dr. Budi Wahyono, SpS
Piamater
Arakhnoid
Duramater
Perjalanan Infeksi
Masa
Inkubasi
Gejala prodromal
Masa infeksi abortif
Bakteriemi
Septikemi
Gejala lokalisatorik
Infeksi Virus
Infeksi Bakteri
Invasi
hematogen
Perkontinuitatum
dari jaringan di
sekitarnya
Pembuluh
MENINGITIS
Inflamasi
Bacterial Pathogen
N meningitidis
S pneumoniae
H influenzae
S pneumoniae
N meningitidis
H influenzae
S pneumoniae
N meningitidis
L monocytogenes
Aerobic gram-negative bacilli
Immunocompromised state
S pneumoniae
N meningitidis
L monocytogenes
Aerobic gram-negative bacilli
Staphylococcus aureus
Coagulase-negative staphylococci
Aerobic gram-negative bacilli, including
Pseudomonas aeruginosa
S pneumoniae
H influenzae
Group A streptococci
CSF shunts
Coagulase-negative staphylococci
S aureus
Aerobic gram-negative bacilli
Propionibacterium acnes
Virus
Enterovirus ; Polio, Echovirus, Coxsackie
Herpes ; HSV
Paramyxovirus ; Mumps, measles
Togavirus ; Rubella
Flavivirus ; Japanese ensefalitis
Retrovirus ; HIV
Meningitis TB
Radang
lama
Gejala meningitis
Tanda rangsang
meningeal
Pemeriksaan Penunjang
Agent
Opening Pressure
Glucose (mg/dL)
Protein (mg/dL)
Microbiology
Bacterial meningitis
200-300
<40
>100
Specific pathogen
demonstrated in 60% of
Gram stains and 80% of
cultures
Viral meningitis
90-200
10-300; lymphocytes
Viral isolation,
PCR assays
Tuberculous meningitis
180-300
100-500; lymphocytes
Reduced, <40
Elevated, >100
Cryptococcal meningitis
180-300
10-200; lymphocytes
Reduced
50-200
Aseptic meningitis
90-200
10-300; lymphocytes
Normal
Negative findings on
workup
Normal values
80-200
0-5; lymphocytes
50-75
15-40
Negative findings on
workup
Penatalaksanaan
Tirah
baring
Pantau respirasi
Pemilihan antibiotik yang tepat dan
cepat
Pada meningitis TB
2HRZE-7RH
2 bulan pertama
INH: 300 mg/hari, oral
Rifampisin: 10 mg/kgBB per hari, oral
Pirazinamid: 30 mg/kgBB/hari, oral
Streptomisin: 15 mg/kg/hari, oral
Etambutol: 15-20 mg/kg/hari, oral
7-12
bulan berikutnya
Steroid
Dexametasone 10 mg bolus intravena,
ENSEFALITIS
Inflamasi
Virus
Manifestasi klinis
demam
Pemeriksaan fisik
Perubahan
status mental
Kelainan fokal (hemiparese, kejang
fokal, gangguan otonom)
Ataksia
Kelainan saraf kranialis
Bacterial Meningitis
Viral Meningitis*
Increased
Typically thousands of
polymorphonuclear cells, but
counts may not change
dramatically or even be normal
(classically in very early
meningococcal meningitis or in
extremely ill neonates)
Glucose
Euglycemia (>50% serum)
Hyperglycemia (>30% serum)
Protein
Preterm (65-150 mg/dL)
Term (20-170 mg/dL
6 mo+ (15-45 mg/dL)
Microorganisms (none)
No organism
Decreased
Normal
Mildly increased
CT
Scan
Penatalaksanaan
Tirah
baring
Pemberian nutrisi parenteral
e/ virus :
Asiklovir diberikan dengan dosis 10 mg/kgBB setiap 8 jam
selama 10 hari atau peroral 200 mg/kgBB 5-6 kali sehari.
Kadar Hemoglobin harus terus dipantau, bila Hb turun sampai
9 g/dl maka dosis diturunkan menjadi 200 mg setiap 8 jam.
Jika Hb turun sampai 7 g/dl maka pengobatan dihentikan
sementara waktu dan diberikan lagi setelah kadar Hb normal
kembali.
e/
bakteri :
Steroid
(dexamethasone)
POLIOMYELITIS
Enterovirus
Fecal oral
transmission
Pembagian Polio
Non
Paralitik Poliomyelitis
Paralitik Poliomyelitis
Paralitik Poliomyelitis dengan
kerusakan bulbar
Penatalaksanaan
Fisioterapi
Intervensi Pembedahan
Vaksin pencegahan
Terima Kasih