DEPARTEMEN PATOLOGI

ANATOMI
FAKULTAS KEDOKTERAN
UNIVERSITAS SUMATERA UTARA
MEDAN
 CNS PNS
Kumpulan dari neuron = nuclei Kumpulan neuron = ganglia

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PERIPHERAL NERVE

The pattern of disease,

reflects the unique structure & function of
nerves
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 INFLAMMATORY
NEUROPATHIES
Characterized by inflammatory cell infiltrates in :

Immune mechanisms
presumed to be the primary cause of the inflammation
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 Immune-Mediated
Neuropathies

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 Guillain-Barr Syndrome

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In some patients :

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 INFECTIOUS
POLYNEUROPATHIES
Many infectious processes affect peripheral nerve

Cause unique and specific pathologic

changes in nerves
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 Biopsies of sural nerves show :

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 Leprosy

involvement Lepromatous &

Peripheral in tuberculoid
nerve leprosy

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 Diphtheria
Peripheral Effects of diphtheria
exotoxin
nerve
involvement

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 Earliest changes seen in :
Sensory ganglia

Incomplete blood-nerve barrier

allows entry of the toxin

Selective demyelination of axons

extends into adjacent anterior &
posterior roots (mixed sensorimotor
nerves)
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 Varicella zoster
The most common viral infections of
PNS

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 Varicella zoster

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 Varicella zoster

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 Classical CNS Disease
Patterns
Degenerative
Inflammatory
Neoplastic
Traumatic
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 BRAIN

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 CELLULAR
REACTIONS
Neurons
Acute (RED neuron, karyolysis)
Subacute
Chronic (cell loss, gliosis)
Axonal Inclusions (lipid, protein,
carbohidrate, viruses)

Glia, gliosis
Swelling
Fibers
Inclusions
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 ACUTE NEURONAL INJURY
RED NEURONS
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 Hallmark Chronic CNS inju

Neuronal loss
&
Gliosis

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 CNS
MALFORMATIONS

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 Fetal -protein in :
Amniotic fluid &
Maternal circulation
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 SPINA
BIFIDA

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 POLYMICROGYRIA
Small gyri

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 HOLOPROSENCEPHALY
Failure prosencephalon to develop, and separate, often leads to cyclops.
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 CEREBRAL
EDEMA
(Normal weight 1200-1300
grams)

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 CEREBRAL EDEM

Gyrus mendatar
Sulcus menyempit
Rongga ventrikel
tertekan
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 CEREBRAL
EDEMA
Subfalcine (SUPRA-
tentorial)
Cingulate (TENTORIAL)
Cerebellar tonsilar (SUB-
tentorial, or INFRA-
tentorial)

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 (SUPRA-tentorial)

(SUB-tentorial / INFRA-tentorial)
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 CEREBRAL
EDEMA
D.D.: SYMPTOMS
EVERYTHIN HEADACHE
G HALLUCINATI
ONS
COMA
DEATH

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HYDROCEPHALU
S

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HYDROCEPHALU
S
Impaired RESORPTION
Increased PRODUCTION

OBSTRUCTION
COMMUNICATING (entire)
NON-COMMUNICATING (part)
HIGH Pressure
NORMAL Pressure
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 Fontanelle closure is the key factor
whether hydrocephalus will result in any
cranial enlargement
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 PERINATAL Brain
Injuries
3 most
common
types of Intra parenchymal
perinatal Hemorrhage
brain
injuries Intra ventricular hemorrhage
(premies)
Periventricular leukomalacia
(i.e., infarcts)
Cerebral Palsy
refers to non-progressive diffuse cerebral
pathology apparent at childbirth

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 Various patterns of CNS injury in newborn

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 CNS TRAUMA
Skull Fractures
Parenchymal Injuries
Traumatic Vascular
Injury
Sequelae
Spinal Cord Trauma
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BRAIN TRAUMA
Contusion (bruise)
Laceration (tear)
Coup/Contre-Coup
Concussion

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 Skull fracture types

HAIRLINE DEPRESSED,
aka
DISPLACED
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 HEMATOMAS/HEMORR
HAGE
EPIDURAL (fx)
SUBDURAL (trauma No fx)
SUBARACHNOID (arterial, no
trauma)
INTRAPARENCHYMAL (any)
INTRAVENTRICULAR (no
trauma, rare in adults,
common in premies)
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 EPIDURAL HEMATOMA

The lucid interval is a classic feature of

the epidural hematoma

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 SUBDURAL HEMATOMA
No lucid interval, but instead a
sudden & progressive worsening of
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05/23/17
SUBARACHNOID
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05/23/17 INTRAPARENCHYMAL
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Most are caused by rupture
of a small intraparenchymal
vessel.
Hypertension is the most
common

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INTRAPARENCHYMAL
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 SPINAL CORD
TRAUMA
Parallels BRAIN patterns of
injury on a cellular basis
Usually secondary to spinal
column displacement
Level of injury mirrors
motor loss: Death
Quadriplegia Paraplegia
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 Cerebrovascular
Diseases
(CVA, Stroke)
Ischemic ( blood and 02)
Global
Focal (regional):
ACUTE:
edema neuronal microvacuolization pyknosis
karyorrhexis neutrophils
CHRONIC:
macrophages gliosis

Hemorrhagic (rupture of
artery/aneurysm)
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 HYPERTENSIVE
CVA
Intracerebral
Basal Ganglia
Region
(lenticulostriate arteries of internal
capsule, putamen)

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 HYPERTENSIVE CVA

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 SUBARACHNOID
HEMORRHAGE
Rupture of large intracerebral
arteries which are the primary
branches of the anatomical
circle (of Willis)
Congenital (berry
aneurysms)
Atherosclerotic (atherosclerotic
aneurysms, or direct wall
rupture)
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 CNS DEGENERATIVE
DISEASES

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 THANK YOU
SELAMAT BELAJAR

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