BAB I

PENDAHULUAN

I. 1 Skenario

Seorang wanita berusia 40 tahun datang dengan keluhan utama sakit

kepala kronis. Sejak 3 bulan SMRS pasien mengeluh sakit kepala berdenyut

diseluruh kepala yang semakin memberat. Sakit kepala terutama timbul pagi

hari. Terkadang disertai muntah tanpa didahului mual. Sakit kepala dirasakan

memberat saat pasien mengedan buang air besar dan batuk

I. 2 Kata Kunci

a. Wanita,40 thn

b. Nyeri kepala kronis, berdenyut

c. Memberat

d. Diseluruh kepala (bilateral)

e. Disertai muntah

f. Memberat saat mengedan & batuk

I. 3 Pertanyaan

1. Struktur atau bangunan apa dari tubuh yang peka nyeri?

2. Bagaimana klasifikasi nyeri kepala?

BAB II

PEMBAHASAN

II.1 Struktrur Peka Nyeri

1. Intrakranial

Struktur-struktur intrakranial yang peka nyeri dan terlibat dalam nyeri

kepala adalah:1

a. Sinus venosus (sinus sagitalis)

b. Arteri duramater (a. Meningea anterior dan media)

c. Duramater dasar tengkorak

d. N. V, N. IX, N. X

e. Arteri yg membentuk sirkulus willisi dan cabang-2-nya

f. Substansia grisea periaquaductal batang otak

g. Nukleus sensoris dari talamus

Gambar 1. Cirkulus Willisi 2

Gambar 2. A.Meningea anterior (kiri). A. Meningea media (kanan) 2

Gambar 3. Sinus venosus intrakranial 3

Gambar 4. Nukleus sensoris dari thalamus 2

2. Ektrakranial

Struktur-struktur ekstrakranial yang peka nyeri dan terlibat dalam nyeri

kepala adalah: 1

a. Kulit, scalp, otot, tendon, dan fascia daerah kepala dan leher

b. Periosteum tengkorak terutama supra orbita, temporal dan oksipital

bawah

c. Rongga orbita beserta isinya

d. Sinus paranasalis, oropharynx dan rongga hidung

e. Gigi geligi

f. Telinga luar dan tengah

g. Arteri ekstra kranial

h. Nervus C2 dan C3

Gambar 5. Struktur peka nyeri ekstrakranial 2,4,5

II.2 Klasifikasi Nyeri Kepala

Klasifikasi nyeri kepala oleh International Headache Society (IHS) 6

1. Nyeri kepala primer

a. Migraine

Migraine without aura

Migraine with aura

Opthalmoplegic migraine

Retinal migraine

Chil periodic syndromes that maybe precursors to or associated

with migraine

Complications of migraine

Migrainous disorder not fulfilling above criteria

b. Tension-type headache

Episodic tensic.r -type headache

Chronic tension-type headache

Headache of the tension-type not fulfilling above criteria

c. Cluster headache and chronic paroxysmal hemicrania

Cluster headache

Chronic paroxysmal hemicrania

Cluster headache-like disorder not fulfilling above criteria

d. Miscellaneous headaches unassociated with structural lesion

Idiopathic stabbing headache

External compression headache

Cold stimulus headache

Benign cough headache

Benign exertional headache

Headache associated with sexual activity

2. Nyeri kepala sekunder

a. Headache associated with head trauma

Acute post-traumatic headache

Chronic post-traumatic headache

b. Headache associated with vascular disorders

Acute ischemic cerebrovascular disorder

Intracranial hematoma

Subarachnoid hemorrhage

Unruptured vascular malformation

Arteritis

Carotid or vertebral artery pain

Venous thrombosis

Arterial hypertension

Headache associated with other vascular disorder

c. Headache associated with nonvascular intracranial disorder

Highcerebrospinalfluidpressure

Low cerebrospinal fluid pressure

Intracranial infection

Intracranial sarcoidosis and other noninfectious inflamma tory

diseases

Headache related to intrathecal injections

Intracranial neoplasm

Headache associated with other intracranial disorder

d. Headache associated with substances or their withdrawal

Headache induced by acute sub stance use or exposure

Headache induced by chronic substance use or exposure

Headache from substance with drawal (acute use)

Headache from substance with drawal (chronic use)

Headache associated with sub stances but with uncertain

mechanism

e. Headache associated with noncephalic infection

Viral infection

Bacterial infection

Headache related to other in fection

f. Headache associated with metabolic disorder

Hypoxia

Hypercapnia

Mixed hypoxia and hypercapnia

Hypoglycemia

Dialysis

Headache related to other metabolic abnormality

g. Headache or facial pain associated with disorder of cranium,

neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or

cranial structures

Cranial bone

Neck

Eyes

Ears

Nose and sinuses

Teeth, jaws, and related structures

Temporomandibular joint disease

h. Cranial neuralgias, nerve trunk pain, and deafferentation pain

Persistent (in Contrast to tic-like) pain of cranial nerve origin

Trigeminal neuralgia

Glossopharyngeal neuralgia

Nervus intermedius neuralgia

Superior laryngeal neuralgia

Occipital neuralgia

Central causes of head and facial pain other than tic douloureux

Facial pain not fulfilling criteria in groups 1 or 12

Daftar Pustaka

1. Price A.S, Wilson M.L. Patofisiologi konsep klinis proses-proses penyakit.

Ed-6. Vol 2 Jakarta: EGC; 2006

2. Penyunting Putz R, Pabst R. Sobotta atlas anatomi manusia [e-book]. Ed 22.

Jakarta: EGC; 2006.

3. Faiz O, Moffat D. Anatomy at a Glance [e-book]. England: Blackwell Science

; 2002

4. Rizzo DC. Instructor’s manual for delmar’s fundamentals of anatomy and

physiology [e-book]. USA: Delmar ; 2001

5. Ellis H. Clinical anatomy arevision and applied anatomy for clinical students

[e-book]. 11st ed. India: Blackwell Publishing ; 2006

Laporan Individu Tutorial Blok Neuropsikiatri

Desember 2011

Struktur Peka Nyeri dan Klasifikasi

Tumor Intrakranial

(modul 1)

Nama : Diky Hardiyansyah

NIM : 09 777 019

Kelompok : IV (empat)

Tutor : dr. Isnania, Sp.S

dr. Magdalena, Sp.S

PROGRAM STUDI PENDIDIKAN DOKTERUNIVERSITAS ALKHAIRAAT PALU

2011