kuliah neuro radiologi
TRANSCRIPT
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Neuro Radiologi
Dr Herman W HadiprodjoSpRad
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Foto polos cranium :1. AP2. LAT3. Towne
Diperhatikan :a. Soft tissue.b. Tabula int dan ext.c. Diploe / sutura.d. Impressio digitatae.e. Vasculer groove.f. Calcifikasi.g. Tanda2 fraktur
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Sella tursica :1. Proc clinoideus ant / post.2. Dorsum sellae.3. Lebar ( ± 10,5 mm ).4. Dalam ( ± 8,1 mm ).
Skull membesar dapat ok :1. Tumor sella – Acromegali.2. Tumor otak.3. Hydrocephalus obstruktiva. a. Tumor cerebellum,pons,vent IV b. Obstruksi ( aquaductus sylvii , ventrikel IV, For magendi/luschka ). c. Adhesi / Pseudotumor.
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Kelainan2 kepala yg sering :1. Microcephalus.2. Hydrocephalus ( congenital / acquired ) 3. Cranio stenosis ( sutura menutup dini ).4. Scapocephali ( sutura sagitalis menutup dini sehingga kepala panjang )5. Turencephali ( paling sering , sutura transversalis menutup dini sehinga kepala seperti tower ).6. Plogiocephali : Prematur ossifikasi separuh sutura sehingga tumbuh tak sempurna.
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Tanda2 T.I.K. naik.1. Sella lebih lebar dan lebih dalam2. Erosi tab interna.3. Impresio digitatae masih tampak (
normal umur 16th
hilang ).4. Sutura melebar.
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Calcifikasi normal :1. Gld pineal / plexus chroideus.2. Falx cerebri / basal ganglia.3. Tentorium cerebelli.4. Lig petroclinoideus.5. Dinding sinus longitudinalis superior dan duramater.6. Habenula.7. Arachnoid granulation.8. Ca deposit dalam a cerebralis.
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Tumor2 otak :1. Tumor supratentorial : a. Astrositoma. b. Gliobastoma. c. Oligoglioma. d. Ependymoma. e. Meningioma. f. Adenoma hyophyse. g. Pinealoma. h. Craniopharyngioma. I . Metastase tumor.
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2. Tumor Infra tentorial : a. Medulloblastoma. b. Ependymoma. c. Astrositoma. d. Neurinoma. e. Meningioma.
Kelainan2 cerebrovasculer :1. Haemorrhagi.2. Infark / thrombosis / emboli.3. Aneurisma.4. Malformasi arteriovenous.
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Malformasi arteriovenous :a. Teleangiectasis capiler.b. Angio cavernosa.c. Angioma venosum.d. AVM.
Trauma capitis :1. Epidural.2. Subdural.3. Subarchnoid bleeding4. Intraparenkimal.
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Anomali SSP :1. Hydrocephalus congenital.2. Agenesis corpus callosum.3. Sturger Weber Syndrome.4. Tuberous Sclerosis. ( penyakit bourneville ).
Lain2 a. Infeksi / abcess b. Atrofi ( gyrus kecil dan sulci melebar ).
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Collumna vertebralis :1. Corpus.2. Arcus vertebralis : a. Pedicle. b. Proc spinosum. c. Proc transversum. d. Facies articularis sup & inf. e. Lamina.
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Canalis vertebralis :1. Bag anterior a. Lig longitudinale posterior. b. Bag posterior corpus vert. c. Bag posterior discus intervert.2. Bag lateral a. Pedicle. b. Facies articularis vertebralis.3. Bag posterior a. Lig flavum. b. Lamina. c. Processus spinosum.
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Dalam canalis vertebralis terdapat :1. Medulla spinalis.2. Syaraf spinal.3. Piamater4. LCS.5. Arachnoid.6. Subdural.7. Duramater.8. Ruang epidural ( antara duramater dan corpus vertebralis )
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Myelografi :Pemeriksaan radiologis untuktujuan melihat struktur canalisspinalis dan pakai kontras nonIonik.
Kontras :1. Negative ( udara ).2. Positive ( zat aktif iodium ). a. Ultravist. b. Iopamiro.Kontras minyak tidak dipakai lagi( ok side efect banyak ).
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Kontras masuk melalui :Lumbal punksi VL II – VL III VL III – VL IV
Masuk ruang subarchnoid,fotoDengan proyeksi AP/LAT/OBL.
Yg masuk melalui suboccipital keCysterna magna ( posisi prone dan lateral ) tidak dipakai lagi.
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Kelainan2 :1. HNP2. Tumor a. Extradural. b. Intradural. -- Intramedullare. -- Extramedulare.3. Kelainan congenital4. Arachnoiditis.
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HNP : Terjadai penonjolan discuske posterior menekan syaraf danmemberikan gangguanneurologis.
Gradasi :1. Protruded : Nucleus menonjol kesatu arah annulus masih baik.2. Prolaps : Nucleus berpindah masuk kedalam lingkaran anulus fibrosus.3. Extruded : Nucleus keluar dari anulus fibrosus dan berada dibawah lig longitudinalis posterior4. Sequestrasi : Nucleus menembus lig longitudinalis posterior
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Tumor Extra dural :1. Metastase.2. Hemangioma.3. Neurofibroma.4. Chordoma.5. Myxoma.6. Ganglioneuroma.
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Intradural Extrameduller :1. Metastase.2. Neurinoma.3. Meningioma.4. Ependymoma.5. Neurofibroma.6. Teratoma.
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Intradural Intrameduller :1. Metastase.2. Glioma.3. Ependymoma.4. Syringomyelia5. Angioma.
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Meningocele :1. Defect tulang.2. Kantong.3. Lokalisasi di mana2.
Diastomatomielia :Spinal cord terpisah/terbelahLongitudinal dalam 2 bagian olehsuatu tulang/tl rawan / jar ikat
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Arnold Chiari Syndrome :Masuknya medulla oblongata kecaudal cerebellum kedalamcanalis spinalis.
Kista meningeal dan radix :1. Kista arachnoid.2. Kista extradural.3. Kista perineural.
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Arachnoiditis :1. Pure arachnoiditis - Sebab tidak jelas. - Sering ok pemberian obat intra thecal.2. Concomitant arachnoiditis - Akibat fraktur , operasi spinal3. Arachnoiditis calcarea - Degenerasi , defisiensi Ca.4. Arachnoiditis ossificans - Defisiensi Ca.
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Arteriografi :1. Carotis.2. Femoral.3. Selective.
Arteriografi bisa untuk :1. Diagnistik.2. Terapi.
Lain2 : CT,MRI,Kedokteran Nuklir
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