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Neurology > Hydrocephalus > Flashcards

Hydrocephalus Flashcards

1
Q

Di mana CSF dihasilkan?

A
  • plexus choroideus yg terletak di ventrikel lateral, ketiga, dan keempat.
  • endotel kapiler di dalam parenkim otak
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2
Q

Pengaruh adrenergik dan kolinergik terhadap produksi CSF

A
  • Adrenergik : menurunkan produksi
  • Kolinergik : meningkatkan produksi
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3
Q

Kecepatan produksi CSF anak

A

20 cc/jam

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4
Q

Aliran normal CSF

A

ventrikel lateral –> foramina Monro –> ventrikel ketiga –> aqueductus Sylvius –> ventrikel keempat –> foramina Luschka (lateral) dan foramen Magendie (media) –> sisterna basalis otak

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5
Q

Lesi tersering pada hidrosefalus obstruktif / non-komunikans

A
  • aqueductus Sylvius
  • ventrike keempat
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6
Q

Ddx hidrosefalus akibat malformasi fossa posterior

A
  • posterior fossa brain tumor
  • Chiari malformation
  • Dandy Walker syndrome
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7
Q

Penyebab hidrosefalus obstruktif / non-komunikans

A
  • meningitis neonatus
  • SAH pada bayi prematur
  • infeksi virus intrauterine (mumps)
  • Galen malformation
  • malformasi fossa posterior
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8
Q

Penyebab hidrosefalus non-obstruktif / komunikans

A
  • SAH
  • meningitis TB / pneumococcus
  • infeksi intrauterine
  • tumor
  • AVM
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9
Q

Tanda dan gejala hidrosefalus

A
  • peningkatan kecepatan head circum
  • fontanel anterior melebar, terbuka, membonjol
  • vena scalp terdilatasi
  • dahi lebar
  • setting sun-eye sign
  • refleks tendon meningkat
  • spastisitas
  • clonus (ext bawah)
  • Babinski (+)
  • perkusi skull: cracked pot sound (Macewen sign)
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10
Q

Mengapa bisa terjadi setting sun-eye sign

A

impingement of dilated suprapineal recess on the brainstem tectum

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11
Q

Kenapa Babinski (+) pada hidrosefalus

A

karena peregangan dan kerusakan corticospinal tract yang berasal dari korteks motorik ekst bawah

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12
Q

Perbedaan occiput pada Chiari dan Dandy Walker malformation

A

Occiput rata –> Chiari malformation
Occiput prominen –> Dandy Ealker malformation

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13
Q

Klasifikasi Chiari malformation

A
  • tipe 1 –> remaja/dewasa, tdk berkaitan dgn hidrosefalus
  • tipe 2 –> hidrosefalus progresif + meningomyelocele
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14
Q

Chiari malformation tipe 1

A
  • obstruksi bagian kaudal ventrikel keempat saat fetus
  • menyebabkan displacement cerebellar tonsil ke cervical canal
  • nyeri kepala rekuren
  • neck pain
  • frekuensi BAK meningkat
  • spastisitas progresif pd ekst bawah
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15
Q

Chairi malformation tipe 2

A
  • anomali hindbrain
  • gagalnya perkembangan pontine flexure
  • menyebabkan elongasi ventrikel keempat dan kinking brainstem –> displacement inferior vermis, pons, MO ke cervical canal
  • bayi: stridor, nangis lemah, apneu –> membaik dgn shunting / deklmpreso fossa posterior
  • abnormalitas gait
  • spastisitas
  • inkoordinasi ekstremitas
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16
Q

Radiologi Chiari malformation tipe 2 (skull xray, CT, MRI)

A
  • Skull xray –> fossa posteriori kecil, cervical canal lebar
  • CT kontras, MRI –> cerebellar tonsil menonjol ke arah cervical canal, hindbrain abnormality
17
Q

Tx Chiari malformation tipe 2

A

Surgical decompression

18
Q

Dandy Walker malformation

A

Ekspansi kistik ventrikel keempat di fossa posterior + midline cerebellar hypoplasia

Penyebab: gagalnya perkembangan atap ventrikel keempat

19
Q

Gejala Dandy Walker malformation

A
  • hidrosefalus
  • agenesis posterior cerebellar vermis dan corpus callosum
  • occiput prominen
  • long tract sign –> refleks tendon meningkat, spastisitas, clonus, Babinski (+)
  • cerebellar ataxia
  • keterlambatan motorik dan kognitif
20
Q

Tx Dandy Walker malformation

A

shunting cystic cavity

21
Q

Anamnesis hidrosefalus

A
  • RPK: curiga X-link atau autosomal hidrosefalus –> stenosis aqueductus
  • riw. prematur, ICH, meningitis, mumps ensefalitis
  • multipel cafe au lait spot, neurofibromatosis
22
Q

Px fisik hidrosefalus

A
  • circum occipitofrontal meningkat
  • dahi prominen, occiput abnormal
  • cranial bruit –> Galen malformation
  • transiluminasi (+)
  • chorioretinitis –> toxo?
  • papiledema
23
Q

Skull xray hidrosefalus

A
  • separation suture
  • erosi posterior clinoid
  • beaten silver appearance di bagian dalam skull krn PTIK lama
24
Q

Definisi megalencephaly

A

brain weight : volume ratio >P98 atau >=2 SD yang disertai macrocephaly (circum occipitofrontal >P98)

25
Q

Penyebab tersering anatomic megalencephaly

A

Benign familial megalencephaly
- RPK keluarga head circum besar
- head growth paralel di upper persentil

26
Q

Ddx megalencephaly macrocephaly syndrome

A

prenatal /postnatal somatic overgrowth
- Sotos syndrome (cerebral gigantism)
- Simpson Golabi Behmel syndrome
- fragile X
- Weaver syndrome
- macrocephaly-cutis marmorata teleangiectativa congenita
- Bannayan Ruvalcaba Riley syndrome

prenatal / postnatal w/o somatic overgrowth
- FG
- Greig cephalopolysyndactyly
- acrocallosal
- Gorlin syndrome

27
Q

Hidransefali

A
  • tidak ada hemisfer cerebri atau digantikan oleh membranous sacs dgn sisa2 korteks frontal, temporal, occipital yg tersebar di dalam membran
  • midbrain dan brainstem masih intak
28
Q

Penyebab hidransefali

A

Oklusi bilateral a.carotis interna saat early fetal development

29
Q

Gejala hidransefali

A
  • iritabel
  • susah makan
  • kejang, spastic quadriparese
  • no cognitive development
30
Q

Tx hidrosefalus

A
  • acetazolamide, furosemide –> menurunkan kec produksi CSF
  • VP shunt
31
Q

Komplikasi shunting (VP shunt)

A
  • oklusi (nyeri kepala, papiledema, muntah, perubahan status mental)
  • infeksi bakteri (S. epidermidis)
32
Q

Kenapa hidrosefalus –> pubertas lebih cepat

A

PTIK –> peningkatan sekresi gonadotropin

Neurology (4 decks)

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