PENCITRAAN PENEGAKAN

DIAGNOSIS GANGGUAN
NEUROLOGI PADA KASUS
INFEKSI

MERARI
SMF RADIOLOGI
FK UNIVERSITAS KRISTEN DUTA WACANA
YOGYAKARTA

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NEUROANATOMI FUNGSIONAL

ANATOMI
Susunan Saraf Pusat (SSP)
Susunan Saraf Tepi (SST)

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 Otak Besar
Otak Otak Kecil
Batang Otak
SSP
C : 8
Medula T : 12
31 sg L : 5
Spinalis
Anatomi S : 5
Co : 1

Susunan
S. Otak : 12 ps I-XII
Saraf
SST
Manusia
S. Spinalis : 31 ps C, T, L, S, Co

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 SUSUNAN SARAF PUSAT

 Dilindungi oleh:
 Tulang:
kranium, vertebrae
 Selaput otak
(meningen):
duramater, araknoid
mater, piamater
 Likuor serebro-
spinalis (LSS)

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SUSUNAN SARAF PUSAT

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LIKUOR SEREBROSPINALIS
 Berasal dari pleksus
koroideus di ventrikel otak:

Ventrikel lateralis (ka & ki)

For interventrikularis
(Monro)
Ventrikel III
Akuaduktus serebri
(Sylvius)
Ventrikel IV
Foramen Luschka &
Magendi
Ruang subaraknoid
Villi araknoidales

Sinus venosus otak

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LIKUOR SEREBROSPINALIS

PRODUKSI

ALIRAN

ABSORBSI

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 KORELASI KLINIK GANGGUAN HIDRODINAMIK
LSS
Produksi  Obstruksi aliran LSS
(papiloma pleksus koroideus) (tumor, perdarahan intraventrikular

Absorbsi 
(meningitis)

HIDROSEFALUS
(dilatasi ventrikel otak)

Hidrosefalus komunikans Hidrosefalus obstruktif

Tekanan intrakranial (TIK) 

HERNIASI OTAK

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HIDROSEFALUS

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OTAK BESAR

 Hemisfer kanan & kiri

 Korteks
 Subkorteks
 Korpus Kalosum

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KORTEKS SEREBRI

 Lobus Frontalis
 Lobus Parietalis
 Lobus Temporalis
 Lobus Oksipitalis
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SUBKORTEKS

 GANGLIA BASALIS
Nukleus kaudatus
Putamen
Globus palidus

 KAPSULA INTERNA
Krus anterior & posterior
Genu

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SUBKORTEKS

DIENSEFALON

 TALAMUS

 HIPOTALAMUS

 SUBTALAMUS

 EPITALAMUS

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BATANG OTAK

 MESENSEFALON
 PONS
 MEDULA OBLONGATA
 INTI-INTI SARAF
KRANIALIS III-XII

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OTAK KECIL

ANATOMI
 Hemisfer kanan & kiri
 Vermis
 Lobus anterior
 Lobus posterior
 Lobus flokulonodularis

FUNGSI
 Koordinasi gerak volunter
 Keseimbangan tubuh
 Tonus otot
 Memory & motor learning

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MEDULA SPINALIS

Segmen servikal: 8

Segmen torakal: 12

Segmen lumbal: 5

Segmen sakral: 5

Segmen koksigeal: 1

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MEDULA SPINALIS

 Funikulus (kolumna)
dorsalis, ventralis,
lateralis
 Kornu anterior, posterior,
intermediolateralis

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SARAF KRANIALES

 N. olfaktorius (I)
 N. optikus (II)
 N. okulomotorius (III)
 N. troklearis (IV)
 N. trigeminus (V)
 N. abdusens (VI)
 N. fasialis (VII)
 N. vestibulokoklearis (VIII)
 N. glosofaringeus (IX)
 N. vagus (X)
 N. asesorius (XI)
 N. hipoglosus (XII)

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MYELOGRAFI
ARAKNOIDITIS

 Inflammation of the meninges and

subarachnoid space
A variety of etiologies
 Infectious : bacterial, viral, fungal, parasitic
agents.
 Noninfectious inflammatory : surgery,
intrathecal hemorrhage, and the
administration of intrathecal agents, such as
myelographic contrast media, anesthetics,
and steroids.
ARACHNOIDITIS

myelogram AP
reveals thickened,
clumped nerve roots
in arachnoiditis.
TOMOGRAFI KOMPUTER KEPALA
(HEAD CT SCAN )
- Noninvasive diagnostic imaging procedure
that uses a combination of X-rays and
computer technology to produce horizontal,
or axial, images (often called slices) of the
body.
- A CT scan shows detailed images of any part
of the body, including the bones, muscles,
fat, and organs.
- CT scans are more detailed than standard X-
rays.
- High Density : hiperdensitas
- Isodensity : isodens
- Low density : hipodens
BRAIN ABSES

 In patients with suspected intraparenchymal sepsis,

pre- and postcontrast scans should be obtained
 Typical appearances include:
 ring of iso- or hyperdense tissue, typically of uniform
thickness
 central low attenuation (fluid/pus)
 surrounding low density (vasogenic oedema)
 ventriculitis may be present, seen as enhancement
of the ependyma
 obstructive hydrocephalus will commonly be seen
when intraventricular spread has occurred
RESONANSI MAGNETIK
(MRI)
- uses a powerful magnetic field, radio waves
and a computer to produce detailed pictures
of the brain and other cranial structures that
are clearer and more detailed than other
imaging methods.
- This exam does not use ionizing radiation
and may require an injection of a contrast
material called gadolinium
Standard brain

 Anatomy brain Sag

 Anatomy brain axial
 MR IMAGING

 T1, T2, FLAIR, Diffusion,

Gadolinium enhanced,
and Angiography are
specific types of Neuro
imaging sequences.
MR INTERPRETATION

 Symmetry
 Identify normal structures
 Ventricles
 Grey matter structures
 White matter tracts
 Description of tissue signal on various different
scanning sequences ie. T1 T2 Flair Diffusion
Gadolinium
MAGNETIC RESONANCE IMAGING

Limitations
1. ICU patients and Claustrophobia
2. Metal artifact

1. RF Energy – pacemaker override

2. Magnetic field - aneurysm clips - ocular metal

-missile effect
3. Nephrogenic Systemic Fibrosis-
gadolinium toxicity in renal failure
MAGNETIC RESONANCE IMAGING

Advantages
1. Multiple signal sources
2. No iodine toxicity/allergy issues
3. No ionizing radiation issues
MR HAS ADVANTAGE OF
MULTI PLANAR IMAGING
 MRI INDICATIONS

 Ischemia
 Tumor
 Infection
 Congenital abnormalities
MRI INTERPRETATION

• Pulse Sequences-
− T1 weighted-- (Fat, Melanin, Hemosiderin,
Methemoglobin= bright)
− T2 weighted-- (Water, Oxyhemoglobin, Hemosiderin=
bright)
− FLAIR-- (Pathology bright, CSF dark)
− Diffusion Weighted- recent infarction bright
MRI SIGNAL
 T1 SCAN
Anatomic structures
Fat = bright
Water = hypo intense

T2
SCAN
Water weighted sequence
Water = bright
Fat = relatively hypo intense
Good for identifying pathology
 GADOLINEUM IMAGING
MR CONTRAST

 ENHANCED SCANS BLOOD/BRAIN

BARRIER DISRUPTION
 IDENTIFY PATHOLOGY

 ARTERIOGRAM EFFECTS
 T1- SCAN – WITHOUT GADOLINEUM

T1 – SCAN WITH GADOLINEUM

T2- SCAN

MR
 PITUITARY
ADENOMA
NORMAL

ABNORMAL
 T1 SAGITTAL MR

WITHOUT GADOLINEUM WITH GADOLINEUM

 VASCULAR ANATOMY
MR ARTERIOGRAM

Anterior cerebral Middle

cerebral
Cavernous Basilar
Carotid artery ICA

ECA

Carotid
ECA bulb
ICA Vertebral
artery CCA

CCA
VASCULAR ANATOMY
Anterior
cerebral
MCA
TIME OF FLIGHT MRA
Basilar Cavernous
TOF-MRA artery carotid

ECA

ICA
BA
MCA
Vertebral
ACA Cavernous
carotid
VASCULAR ANATOMY
ACA

MCA

ACoA
ICA PCoA
PCA

Basilar Artery

Circle of Willis
VASCULAR DISTRIBUTIONS

ACA

MCA
PCA
SPINAL MRI
SPINAL INFECTION
TERIMA KASIH