Patologi Anatomy Brain and Mind System

DEPARTEMEN PATOLOGI
ANATOMI
FAKULTAS KEDOKTERAN
UNIVERSITAS SUMATERA UTARA
MEDAN
CNS
Kumpulan dari neuron = nuclei
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PNS
Kumpulan neuron = ganglia
DEP. PATOLOGI ANATOMI FK-USU

2013
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BRAIN
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Have :
Cell body
Dendrites
intergrating
signals
Axon
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Glial divided into :
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CELLULAR
REACTIONS
Neurons
Acute (RED neuron, karyolysis)
Subacute, chronic, cell loss, gliosis
Axonal
Inclusions (lipid, prot., carb., 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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Normal motor
units :
Two adjacent motor units
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Abnormal motor
units
Segmental demyelination:
Random internodes of myelin are injured
Remyelinated by multiple Schwann cells
Axon & myocytes remain

intact
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Abnormal motor
units
Axonal degeneration:
Axon & myelin sheath
undergo anterograde
degeneration (green)
Resulting :
Denervation atrophy
of the myocytes within
its motor unit
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Abnormal motor
units
Reinnervation of muscle:
Sprouting of adjacent (red)

uninjured motor axons
leads to fiber type
grouping of myocytes
Injured axon attempts
axonal sprouting
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Abnormal motor
units
Myopathy :
Scattered myocytes of
adjacent motor units are
small (degenerated /
regenerated)
Neurons & nerve fibers are
normal
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PERIPHERAL NERVE
Same categories of
disease as other
tissues
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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Is a life-threatening disease PNS
Incidence
(U.S.) 1 -3 /
100.000
persons
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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
Peripheral
nerve
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involvement
in

2013
Lepromatous &
tuberculoid
leprosy
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Diphtheria
Peripheral
nerve
involvement
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Effects of diphtheria
exotoxin

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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 Disease
Patterns
Degenerative
Inflammatory
Neoplastic
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Classical CNS Disease

Patterns
Degenerative
Inflammatory
Neoplastic
Traumatic
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CNS
MALFORMATIONS
Neural Tube
Anencephaly, Encephalocele, Spina Bifida
Forebrain
Polymicrogyria, Holoprosencephaly,
Agenesis of Corpus Callosum
Posterior Fossa (Infratentorial)

Arnold Chiari (infratentorial herniation),
Dandy-Walker (cerebellar cyst)
Syringomyelia/Hydromyelia
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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 (SUPRAtentorial)
Cingulate (TENTORIAL)
Cerebellar tonsilar (SUBtentorial, or INFRAtentorial)
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CEREBRAL
EDEMA
D.D.:
SYMPTOMS
EVERYTHIN
G
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HEADACHE
HALLUCINATI
ONS
COMA
DEATH

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HYDROCEPHALU
S
Impaired RESORPTION
Increased PRODUCTION
OBSTRUCTION
COMMUNICATING (entire)
NON-COMMUNICATING (part)
HIGH Pressure
NORMAL Pressure
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PERINATAL Brain
Injuries
Three most
common
types of
perinatal
brain
injuries
Intraparenchymal
Hemorrhage
Intraventricular 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
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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
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No lucid interval, but instead a

sudden & progressive worsening of
DEP. PATOLOGI ANATOMIsymptoms
FK-USU
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2013
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SUBARACHNOID
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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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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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Patologi Anatomy Brain and Mind System

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DEPARTEMEN PATOLOGI

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

Glial divided into :

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

ACUTE NEURONAL INJURY

DEP. PATOLOGI ANATOMI FK-USU

Hallmark Chronic CNS inju

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

Random internodes of myelin are injured

Remyelinated by multiple Schwann cells

Axon & myocytes remain

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

Sprouting of adjacent (red)

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

The pattern of disease,

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

Is a life-threatening disease PNS

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

Cause unique and specific pathologic

DEP. PATOLOGI ANATOMI FK-USU

Biopsies of sural nerves show :

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

Earliest changes seen in :

Incomplete blood-nerve barrier

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

Classical CNS Disease

DEP. PATOLOGI ANATOMI FK-USU

Anencephaly, Encephalocele, Spina Bifida

Posterior Fossa (Infratentorial)

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

Failure prosencephalon to develop, and separate, often leads to cyclops.

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU

DEP. PATOLOGI ANATOMI FK-USU