ILMU PENYAKIT MATA

53. Vitamin A Deficiency

myorganicchemistry.wikispaces.com
Retinol elaboration of
rhodopsin by the rods
the sensory receptors of the
retina responsible for vision
under low levels of
illumination
Vitamin A deficiency
interfere with rhodopsin
production
impair rod function
Night blindness
VITAMIN A DEFICIENCY AND ITS CONSEQUENCES A field guide to detection
and control. Alfred Sommer. World Health Organization. Geneva:1995
Conjunctival Xerosis
The epithelium of the conjunctiva transformed to the stratified squamous typeLoss of goblet
cells, formation of a granular cell layer and keratinization of the surface
N columnar cell
appears in the temporal quadrant
Therapy o resolve within 25 days, most will disappear within 2 weeks
Night blindness
Responds rapidly, usually within 2448 hours to vitamin A therapy
Corneal Xerosis
responds within 25 days with the cornea regaining its normal appearance in 12 weeks
Xerophthalmia Fundus
disappear within 24 months in response to vitamin A therapy
VITAMIN A DEFICIENCY AND
ITS CONSEQUENCES A field
guide to detection and control.
Alfred Sommer. World Health
Organization. Geneva:1995
http://www.moondrag
on.org/health/disorders
/xerophthalmia.html
54. REFRACTIVE DISORDER
Refractive Disorder
Myopia Concave lens. The smallest
Dioptri to corret the visual
aquity to 6/6
Minus lenses to be used to
correct myopia should be no
stronger than abso-
lutely necessary.
Accommodative asthenopia
(rapid ocular fatigue) results
from the excessive stress
caused by chronic con-
traction of the atrophic
ciliary muscle.
55. Cataract
Any opacity of the lens or loss of transparency of the lens that causes
diminution or impairment of vision
Classification : based on etiological, morphological, stage of maturity
Etiological classification :
Senile
Traumatic (penetrating, concussion, infrared irradiation, electrocution)
Metabolic (diabetes, hypoglicemia, galactosemia, galactokinase deficiency,
hypocalcemia)
Toxic (corticosteroids, chlorpromazine, miotics, gold, amiodarone)
Complicated (anterior uveitis, hereditary retinal and vitreoretinal disorder, high
myopia, intraocular neoplasia
Maternal infections (rubella, toxoplasmosis, CMV)
Maternal drug ingestion (thalidomide, corticosteroids)
Presenile cataract (myotonic dystrophy, atopic dermatitis)
Syndromes with cataract (downs syndrome, werners syndrome, lowes
syndrome)
Hereditary
Secondary cataract
http://sdhawan.com/ophthalmology/lens&cataract.pdf E-mail: sdhawan@sdhawan.com
Cataract

Sign & symptoms:
Near-sightedness (myopia shift)
Early in the development of age-related
cataract, the power of the lens may be
increased
Reduce the perception of blue
colorsgradual yellowing and
opacification of the lens
Gradual vision loss
Almost always one eye is affected
earlier than the other
Shadow test +

Morphological classification :
Capsular
Subcapsular
Nuclear
Cortical
Lamellar
Sutural
Stage of maturity classification:
Immature
Mature
Intumescent
Hypermature
Morgagnian
Chronological classification:
Congenital (since birth)
Infantile ( first year of life)
Juvenile (1-13years)
Presenile (13-35 years)
Senile


Katarak Traumatik
Paling sering disebabkan oleh cedera benda asing di lensa atau
trauma tumpul bola mata
Sering mengenai pekerja industri
Gejala dan Tanda:
Penglihatan kabur mendadak
Mata merah
Lensa opak
Perdarahan intraokular
gambaran bintang pada lensa posterior yang dapat dilihat
melalui pupil yang dilatasi maksimal
Komplikasi : infeksi, uveitis, ablasio retina, glaukoma
Tatalaksana : antibiotik sistemik dan topikal, kortikosteroid topikal,
katarak dikelurakan pada saat pengeluaran benda asing atau
setelah peradangan mereda
Inflammatory diseases
Ocular toxocariasis
Congenital toxoplasmosis
Congenital cytomegalovirus retinitis
Herpes simplex retinitis
Other types of fetal iridochoroiditis
Pseudo-uveitis
Endophthalmitis
Tumors
Retinoblastoma
Medulloepithelioma
Naevoxanthome juvenile
Glioneuroma
Leukemia
Choroidal hemangioma
Combined retinal hamartoma
Congenital malformations
Persistent Hyperplastic Fetal Vasculature (PHFV)
Posterior coloboma
Retinal fold
Myelinated nerve fibres
Morning Glory Syndrome
X-linked retinoschisis
Retinal dysplasia
Norries disease
Incontinentia pigmenti
Phakomatoses
Astrocytic hamartoma (Bournevilles tuberous
sclerosis)
Retinal capillary hemangioma (von Hippel-
Lindau)
Encephalotrigeminal syndrome (Sturge-
Weber)
Neurofibromatosis (von Recklinhausen) (NF1
Divers
Vitreous hemorrhage
Retinal detachment
Strabismus (Brckners phenomenon)
Stickler syndrome
Trauma
Contusion of the globe
Intraocular foreign body
Shaken baby syndrome
Vascular diseases
Retinopathy of prematurity
Coats disease
Familial exudative vitreoretinopathy
56. Differential Diagnosis
in Pediatric Leukocoria
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Retinoblastoma
Retinoblastoma (Rb) is a rapidly
developing cancer that develops in
the cells of retina, the light-detecting
tissue of the eye.
Caused by a mutation in a gene
controlling cell division, causing cells
to grow out of control and become
cancerous.
Signs and Symptoms :
The pupil of the eye appears white instead
of red when light shines into it (known as
"cat's eye reflex" or "white eye"). This may
be seen in flash photographs of the patient.
The eyes appear to be looking in different
directions (crossed eyes).
Pain or redness in the eye.
An enlarged or dilated pupil
Blurred vision or poor vision
Different colored irises

Treatment : The priority is to
preserve the life of the child, then to
preserve vision, and then to
minimize complications or side
effects of treatment.
Treatment options :chemotherapy,
cryotherapy, radioactive plaques,
laser therapy, external beam
radiotherapy and surgical removal of
the eyeball (enucleation)
Retinoblastoma

Katarak sejenis kerusakan mata yang menyebabkan lensa mata berselaput
dan rabun. Lensa mata menjadi keruh dan cahaya tidak dapat
menembus
Ablasio retina Lepasnya retina sensorik dari RPE akibat adanya robekan, tarikan
atau terkumpulnya cairan pada retina. Gejala:vitreous floaters,
fotopsia, terhalang pandangan tepi seperti ada tirai
Displasia retina an eye disease affecting the retina of animals and, less commonly,
humans. It is usually a nonprogressive disease and can be caused
by viral infections, drugs, vitamin A deficiency, or genetic defects.
Retinal dysplasia is characterized by folds or rosettes (round
clumps) of the retinal tissue.
Fibroplasia retrolental a disease of the eye affecting prematurely-born babies generally
having received intensive neonatal care. It is thought to be caused
by disorganized growth of retinal blood vessels which may result
in scarring and retinal detachment. Risk factor: prematurity,
oxygen toxicity
Inflammatory diseases
Ocular toxocariasis
Congenital toxoplasmosis
Congenital cytomegalovirus retinitis
Congenital cataract
Herpes simplex retinitis
Other types of fetal iridochoroiditis
Pseudo-uveitis
Endophthalmitis
Tumors
Retinoblastoma
Medulloepithelioma
Naevoxanthome juvenile
Glioneuroma
Leukemia
Choroidal hemangioma
Combined retinal hamartoma
Congenital malformations
Persistent Hyperplastic Fetal Vasculature (PHFV)
Posterior coloboma
Retinal fold
Myelinated nerve fibres
Morning Glory Syndrome
X-linked retinoschisis
Retinal dysplasia
Norries disease
Incontinentia pigmenti
Phakomatoses
Astrocytic hamartoma (Bournevilles
tuberous sclerosis)
Retinal capillary hemangioma (von Hippel-
Lindau)
Encephalotrigeminal syndrome (Sturge-
Weber)
Neurofibromatosis (von Recklinhausen) (NF
1
Divers
Vitreous hemorrhage
Retinal detachment
Strabismus (Brckners phenomenon)
Stickler syndrome
Trauma
Contusion of the globe
Intraocular foreign body
Shaken baby syndrome
Vascular diseases
Retinopathy of prematurity
Coats disease
Familial exudative vitreoretinopathy
57. Differential Diagnosis
in Pediatric Leukocoria
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Katarak Kongenital
Perubahan pada kebeningan struktur lensa mata yang muncul pada
saat kelahiran bayi atau segera setelah bayi lahir dengan usia < 1 tahun
Unilateral/Bilateral
Keruh/buram di lensa terlihat sebagai bintik/bercak putih dan dapat
dilihat dengan mata telanjang
Faktor resiko :kelainan kromosom, atau gangguan penyakit maternal
selama masa kehamilan seperti penyakit metabolis (galaktosemia),
infeksi intraurin (rubella pada trimester pertama), pemakaian obat
selama kehamilan, toksoplasmosis, DM, hipoparatiroidism
Penyulit : makula lutea tidak cukup mendapat rangsangan tidak
berkembang sempurna ambliopia sensoris; nistagmus; strabismus
Pengobatan : operasi.
Ilmu Penyakit Mata, Sidarta Ilyas, 2005
Retinoblastoma Keganasan pada sel retina. Tampak seperti mata kucing/mata
memantulkan cahaya putih, pupil tampak membesar
Ablasio retina Lepasnya retina sensorik dari RPE akibat adanya robekan, tarikan
atau terkumpulnya cairan pada retina. Gejala:vitreous floaters,
fotopsia, terhalang pandangan tepi seperti ada tirai
Displasia retina an eye disease affecting the retina of animals and, less commonly,
humans. It is usually a nonprogressive disease and can be caused
by viral infections, drugs, vitamin A deficiency, or genetic defects.
Retinal dysplasia is characterized by folds or rosettes (round
clumps) of the retinal tissue.
Fibroplasia retrolental a disease of the eye affecting prematurely-born babies generally
having received intensive neonatal care. It is thought to be caused
by disorganized growth of retinal blood vessels which may result
in scarring and retinal detachment. Risk factor: prematurity,
oxygen toxicity
58. KORNEA
uveitis posterior
perdarahan vitreous
Ablasio retina
oklusi arteri atau
vena retinal
neuritis optik
neuropati optik akut
karena obat
(misalnya
etambutol), migrain,
tumor otak
MATA TENANG
VISUS TURUN
PERLAHAN
MATA TENANG
VISUS TURUN
MENDADAK
MATA MERAH
VISUS NORMAL
MATA MERAH
VISUS TURUN
Keratitis
Keratokonjungt
ivitis
Ulkus Kornea
Uveitis
glaukoma akut
Endoftalmitis
panoftalmitis
Katarak
Glaukoma
retinopati
penyakit
sistemik
retinitis
pigmentosa
kelainan
refraksi
konjungtivitis
murni
Trakoma
mata kering,
xeroftalmia
Pterigium
Pinguekula
Episkleritis
skleritis
ANAMNESIS
mengenai media
refraksi (kornea,
uvea, atau
seluruh mata)
struktur yang
bervaskuler
sklera
konjungtiva
tidak
menghalangi
media refraksi
Corneal Ulcer
An inflammatory or more seriously, infective condition of the cornea
involving disruption of its epithelial layer with involvement of the
corneal stroma (Fluoresens test (+))
Causative Agent Feature Treatment
Fungal Fusarium & candida species, conjungtival
injection, satellite lesion, stromal infiltration,
hypopion, anterior chamber reaction
Natamycin,
amphotericin B,
Azole derivatives,
Flucytosine 1%
Protozoa infection
(Acanthamoeba)
associated with contact lens users swimming in
pools
Viral HSV is the most common cause, Dendritic
lesion, decrease visual accuity
Acyclovir
Staphylococcus
(marginal ulcer)
Rapid corneal destruction; 24-48 hour, stromal
abscess formation, corneal edema, anterior
segment inflammation. Centered corneal ulcers.
Traumatic events, contact lens, structural
malposition
Tobramycin/cefazoli
n eye drops,
quinolones
(moxifloxacin)
Pseudomonas
Streptococcus
connective tissue
disease
RA, Sjgren syndrome, Mooren ulcer, or a
systemic vasculitic disorder (SLE)
http://emedicine.medscape.com/article/798100
59. RETINOPATI
uveitis posterior
perdarahan vitreous
Ablasio retina
oklusi arteri atau
vena retinal
neuritis optik
neuropati optik akut
karena obat
(misalnya
etambutol), migrain,
tumor otak
MATA TENANG
VISUS TURUN
PERLAHAN
MATA TENANG
VISUS TURUN
MENDADAK
MATA MERAH
VISUS NORMAL
MATA MERAH
VISUS TURUN
Keratitis
Keratokonjungt
ivitis
Ulkus Kornea
Uveitis
glaukoma akut
Endoftalmitis
panoftalmitis
Katarak
Glaukoma
retinopati
penyakit
sistemik
retinitis
pigmentosa
kelainan
refraksi
konjungtivitis
murni
Trakoma
mata kering,
xeroftalmia
Pterigium
Pinguekula
Episkleritis
skleritis
ANAMNESIS
mengenai media
refraksi (kornea,
uvea, atau
seluruh mata)
struktur yang
bervaskuler
sklera
konjungtiva
tidak
menghalangi
media refraksi
RETINOPATI HIPERTENSI
Kelainan retina dan pembuluh darah retina akibat tekanan
darah tinggi arteri besarnya tidak teratur, eksudat pada
retina, edema retina, perdarahan retina
Kelainan pembuluh darah dapat berupa : penyempitan
umum/setempat, percabangan yang tajam, fenomena crossing,
sklerose
Pada retina tampak : akibat sklerose (refleks copper wire/silver
wire, lumen pembuluh irreguler, fenomena crossing);
perdarahan atau eksudat retina (gambaran seperti bintang,
cotton wool patches); perdarahan vena (flame shaped)
Ilmu Penyakit Mata, Sidarta Ilyas, 2005
CLASSIFICATION SYMPTOMS FEATURE
Mild non-proliferative (mild
pre-proliferative)
None Microaneurysms only, reflects structural
changes in the retina
Proliferative retinopathy Floaters, sudden
visual loss
New vessel formation either at the disc
(NVD) or elsewhere (NVE), vitreous or
preretinal haemorrhage
Central and branch retinal
artery occlusion
Penurunan
penglihatan
hebat yang tidak
nyeri yang terjadi
dalam periode
beberapa detik.
Funduskopi : retina superfisialis mengalami
pengeruhan kecuali di foveola cherry red
spot
Central and branch retinal vein
occlusion
penurunan
penglihatan
mendadak yang
tidak nyeri
perdarahan retina kecil-kecil tersebar dan
bercak cotton-wool, dapat juga gambaran
perdarahan hebat dengan perdarahan retina
superfisialis dan dalam, vena melebar dan
berkelok-kelok, edema makula dan retina
http://bestpractice.bmj.com/best-
practice/monograph/532/basics/classification.html
http://medweb.bham.ac.uk/easdec/gradingretinopathy.htm
60-61. KONJUNGTIVITIS
Pathology Etiology Feature Treatment
Bacterial staphylococci
streptococci,
gonocci
Corynebacteri
um strains
Acute onset of redness, grittiness,
burning sensation, usually bilateral
eyelids difficult to open on waking,
diffuse conjungtival injection,
mucopurulent discharge, Papillae +
topical antibiotics
Artificial tears
Viral Adenovirus
herpes
simplex virus
or varicella-
zoster virus

Unilateral watery eye, redness,
discomfort, photophobia, eyelid
edema & pre-auricular
lymphadenopathy, follicular
conjungtivitis, pseudomembrane
(+/-)
Days 3-5 of worst, clear up
in 714 days without
treatment
Artificial tears relieve
dryness and inflammation
(swelling)
Antiviral herpes simplex
virus or varicella-zoster virus
http://www.cdc.gov/conjunctivitis/about/treatment.html
Conjunctivitis is swelling (inflammation) or infection
of the membrane lining the eyelids (conjunctiva)
Pathology Etiology Feature Treatment
Fungal Candida spp. can
cause
conjunctivitis
Blastomyces
dermatitidis
Sporothrix
schenckii
Not common, mostly occur in
immunocompromised patient,
after topical corticosteroid and
antibacterial therapy to an
inflamed eye
Topical antifungal
Vernal Allergy Chronic conjungtival bilateral
inflammation, associated atopic
family history, itching,
photophobia, foreign body
sensation, blepharospasm,
cobblestone pappilae, Horner-
trantas dots
Removal allergen
Topical antihistamine
Vasoconstrictors
Inclusion Chlamydia
trachomatis
several weeks/months of red,
irritable eye with mucopurulent
sticky discharge, acute or
subacute onset, ocular irritation,
foreign body sensation,
watering, unilateral ,swollen
lids,chemosis ,Follicles
Doxycycline 100 mg
PO bid for 21 days OR
Erythromycin 250 mg
PO qid for 21 days
Topical antibiotics

62. Cataract
Any opacity of the lens or loss of transparency of the lens that causes
diminution or impairment of vision
Classification : based on etiological, morphological, stage of maturity
Etiological classification :
Senile
Traumatic (penetrating, concussion, infrared irradiation, electrocution)
Metabolic (diabetes, hypoglicemia, galactosemia, galactokinase
deficiency, hypocalcemia)
Toxic (corticosteroids, chlorpromazine, miotics, gold, amiodarone)
Complicated (anterior uveitis, hereditary retinal and vitreoretinal
disorder, high myopia, intraocular neoplasia
Maternal infections (rubella, toxoplasmosis, CMV)
Maternal drug ingestion (thalidomide, corticosteroids)
Presenile cataract (myotonic dystrophy, atopic dermatitis)
Syndromes with cataract (downs syndrome, werners syndrome,
lowes syndrome)
Hereditary
Secondary cataract
http://sdhawan.com/ophthalmology/lens&cataract.pdf E-mail: sdhawan@sdhawan.com

Sign & symptoms:
Near-sightedness (myopia
shift) Early in the development
of age-related cataract, the
power of the lens may be
increased
Reduce the perception of blue
colorsgradual yellowing and
opacification of the lens
Gradual vision loss
Almost always one eye is
affected earlier than the other
Shadow test +

Morphological classification :
Capsular
Subcapsular
Nuclear
Cortical
Lamellar
Sutural
Stage of maturity classification:
Immature
Mature
Intumescent
Hypermature
Morgagnian
Chronological classification:
Congenital (since birth)
Infantile ( first year of life)
Juvenile (1-13years)
Presenile (13-35 years)
Senile

Cataract
Treatment : Surgery
Cataract surgery is the removal of the natural lens of the eye that has
developed an opacification then an artificial intraocular lens implant is
inserted
Pirenoxine (Catalin) is a medication used in the possible treatment and
prevention of cataracts.
A report in the journal of Inorganic Chemistry showed that in liquid solutions
Pirenoxine could cause decreased cloudiness of a crystallin solution produced
to mimic the environment of the eye.
Abstract of a research on how pirenoxine (PRX) interacts with selenite or
calcium ions that have been proven as factors leading to the formation of
lens cataract is available at
http://pubs.acs.org/stoken/presspac/presspac/full/10.1021/ic102151p
Researchers found that pirenoxine reduced the cloudiness of the lens
solution containing calcium by 38 percent and reduced the cloudiness of the
selenite solution by 11 per cent.
http://en.wikipedia.org/wiki/Pirenoxine
Quinolone A family of synthetic broad-spectrum antibacterial drugs
Pilokarpine A parasympathomimetic alkaloid, used to treat chronic open-
angle glaucoma, acute angle-closure glaucoma
Betamethasone Corticosteroid for eye inflammation. Contraindicated in fungal
infections and hypersensitivity
Hidroksietilselulosa Eye lubricants, for dry and irritated eye
63. TRAUMA
Trauma tumpul menyebabkan peningkatan tekanan dalam
orbita dan intraokular disertai deformitas bola mata.
Tanda: nyeri ringan, kekaburan penglihatan, kemosis
hemoragik, laserasi konjungtiva, kamera anterior dangkal
dengan atau tanpa dilatasi pupil yang eksentrik, ablasi retina,
hifema, atau perdarahan korpus vitreosus
Ablasio Retina
Ablasio retina adalah suatu keadaan terpisahnya sel kerucut dan batang
retina (retina sensorik) dari sel epitel pigmen retina
Mengakibatkan gangguan nutrisi retina pembuluh darah yang bila
berlangsung lama akan mengakibatkan gangguan fungsi penglihatan
Terdapat tiga jenis utama/penyebab ablasio retina yaitu : ablasi retina
regmategenosa, ablasi retina traksi (tarikan) dan ablasi retina eksudatif
Gejala : vitreous floaters, fotopsia, terhalangnya pandangan tepi seperti ada
tirai, metamor-fopsia, dan penurunan visus, Ada semacam tirai tipis
berbentuk parabola yang naik perlahan-lahan dari mulai bagian bawah bola
mata dan akhirnya menutup pandangan
Funduskopi : adanya robekan retina, retina yang terangkat berwarna keabu-
abuan, biasanya ada fibrosis vitreous atau fibrosis preretinal bila ada traksi.
Bila tidak ditemukan robekan kemungkinan suatu ablasio nonregmatogen
Pengobatan: konservatif(untuk nonregmatogen), pneumatic retinopexy,
bakel sklera, vitrektomi tertutup

Vaughn DG, Oftalmologi Umum, ed.14
Hifema Blood in the front (anterior) chamber of the eye a reddish tinge,
or a small pool of blood at the bottom of the iris or in the cornea
Luksasio lensa Dislokasi lensa dapat pada anterior atau posterior. Anterior :
penglihatan turun mendadak, sakit yang sangat, muntah, mata
merah dengan blefarospasme, injeksi siliar, edema kornea.
Posterior : skotoma pada lapang pandang dan gejala afakia
Iridosiklitis Radang uvea anterior. Gejala : mata merah, pupil kecil, nyeri,
fotofobia, penglihatan turun ringan dan berair
Perdarahan vitreum Sering timbul pada penderita DM, hipertensi, dan anemia sabit.
Gejala :penglihatan buram tiba-tiba, peningkatan floater/kilatan
cahaya
64. Eyelids Disorders
Pathology Feature
Chalazion
(meibomian gland
lipogranuloma)
Chronic inflamation of Zeis/Meibom gland; when acutely inflammed Painful,
warm, swollen, and firm eyelids, granulomatous reaction, lipogranuloma, usually
on the upper eyelid and inside the lid, painless nodules, Increased tearing,
Sensitivity to light
Hordeolum Localized infection or inflammation of the eyelid margin involving hair follicles of
the eyelashes (external hordeolum) or meibomian glands (internal
hordeolum),Staphylococcal infection; painful, warm, swollen, and tender eyelids,
focal collection of PMN cells and necrotic tissue. erythematous, and
localized,Purulent material exudates
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http://www.healblog.net/wp-content/uploads/Hordeolum-and-
Chalazion.jpg
Chalazion
The result of obstruction of the duct of a meibomian gland, which is usually
idiopathic, with secondary lipogranulomatous inflammation
Epidemiology : higher incidence in seborrheoc dermatitis, rosacea, and DM
Clinical features : a pale, round, firm lesion of the lid.
Diagnosis : made clinically
Treatment : incision of the cyst and removed by curetting. Steroid injection
can initiate remission
Prognosis : ocaasionally recurrent
NEUROLOGI
65. CAUDA EQUINA SYNDROME
Cauda equina syndrome (CES) is a rare syndrome that has been described as a complex of
symptoms and signslow back pain, unilateral or bilateral sciatica, motor weakness of
lower extremities, sensory disturbance in saddle area, and loss of visceral function
resulting from compression of the cauda equina.
CES occurs in approximately 2% of cases of herniated lumbar discs and is one of the few
spinal surgical emergencies.
Etiology : tumors, trauma, spinal stenosis, inflammatory conditions
Signs : include weakness of the muscles of the lower extremeties innervated by the
compressed lumbar roots (often paraplegia), detrusor weaknesses causing urinary
retention and post-void residual incontinence, decreased anal tone and consequent fecal
incontinence; sexual dysfunction; saddle anesthesia; bilateral (or unilateral) sciatic leg pain
and weakness; and absence of ankle reflex. Pain may, however, be wholly absent; the
patient may complain only of lack of bladder control and of saddle-anaesthesia, and may
walk into the consulting-room.
Red Flag Symptoms:(requiring urgent hospitalisation) include sciatic leg pain and/or severe
back pain, with altered sensation over saddle area (genitals, uretha, anus, inner thighs),
urine retention or incontinence
Diagnosis : CT or MRI
Treatment : Surgical decompression
http://en.wikipedia.org/wiki/Cauda_equina_syndrome
66-67. HEAD INJURY
Brain hematoma : a collection of blood within brain tissue.
Hematoma inside the cranium is named according to its
location:
Subdural hematoma: blood collection between brain and dura
Epidural hematoma: blood collection between dura and the
skull
Subarachnoid Hemorrhage: beneath the arachnoid membrane
Intracerebral hematoma: blood collection within the brain
Subdural Hematoma
A collection of blood below the inner layer of the dura but external to the brain
and arachnoid membrane.
Subdural hematoma is the most common type of traumatic intracranial mass
lesion.
Usually resulting from tears in bridging veins which cross the subdural space
May cause an increase in intracranial pressure (ICP) compression of and
damage to delicate brain tissue
Characterized on the basis of their size and location and the amount of time
elapsed since the inciting event age (ie, whether they are acute, subacute, or
chronic) :
Acute subdural hematomas: less than 72 hours old and are hyperdense compared with
the brain on computed tomography scans.
Subacute phase: begins 3-7 days after acute injury; the surgical literature favors 3 days,
whereas the radiological literature favors 7. Subacute subdural hematomas are isodense
or hypodense compared with the brain.
Chronic subdural hematomas are 21 days (3 wk) or older and are hypodense compared
with the brain. However, may be mixed in nature, such as when acute bleeding has
occurred into a chronic subdural hematoma.
Symptoms: gradually increasing headache and confusion.
CT Appearance : crescent shape
Treatment: depends on the size and rate of growth. Careful monitoring, insertion
of small catheher suck the blood, craniotomy removal of hematoma
http://emedicine.medscape.com/article/1137207
Epidural Hematomas
70%-80% located in
temporoparietal region where
skull fractures cross the path of
middle meningeal artery or its
dural branches
May present with lucid period
immediately after trauma and a
delay before symptoms evident
on CT : Lens shaped (biconvex
lens) hematomas that do not
cross suture lines
Crescent shaped density that may run length of skull
Subdural hematomas : crescent shaped density
that may run length of the skull
Subarachnoid
Hemorrhage
Intracranial Hemorrhage
Menurut Penyebab Stroke dibagi :
1. Stroke Hemoragik
a. Intra cerebral hemoragik (ICH)
OK : Hypertensi, Aneurysma dan arterioveneus Malformasi (AVM)
b. Sub Arachnoid Hemoragik (SAH)
diagnosis medis : CT brain scan
2. Stroke Non Hemoragik (Iskemik)
OK : Arteriosklerosis & sering dikaitkan dengan : DM,
Hypercolesterolemia, Asam urat, hyperagregasi trombosit
3. Emboli Sumber dari tronkus di arteria carotis communis di jantung
Lepas trombus embolus otak.
68. STROKE
Stroke
Manifestasi Klinis :
Kelumpuhan wajah atau anggota
badan (biasanya hemiparese),
timbul mendadak
Gangguan hemisensorik
Perubahan mendadak status
mental
Afasia; disartria
Gangguan penglihatan atau
diplopia
Ataksia
Vertigo, mual, muntah, nyeri
kepala
Faktor Resiko :
Usia
Riw. TIA atau stroke
Peny. Jantung koroner
Hipertensi
DM
Merokok
Dislipidemia

Intracerebral Hemorrhage
Bleeding into brain tissue
Usually caused by chronic
hypertension
Non-hypertension cause more
likely if:
No past history of
hypertension
Lobar (i.e., peripheral, not
subcortical)
May require emergency surgery
Accounts for 10% of strokes
Hemorrhage:
Symptoms only suggestive of
hemorrhage.
CT or LP needed for definitive
diagnosis
Headache
Neck stiffness
Neck pain
Light intolerance
Nausea, vomiting
Decreased consciousness

Pada kasus ini tidak didapatkan tanda-
tanda kemungkinan stroke hemoragik
jadi kemungkinan yang terjadi adalah
stroke iskemik
69. HEADACHE

MIGRAINE
70. MENINGITIS
Meningitis: radang pada selaput otak yang melapisi otak dan
sumsum tulang belakang
Manifestasi klinis : nyeri kepala, dapat menjalar ke tengkuk dan
punggung, kaku kuduk, kernig (+), brudzinsky (+)
Klasifikasi (berdasarkan perubahan pada cairan otak) :
Meningitis serosa : cairan otak jernih, paling sering disebabkan oleh
Mycobacterium tuberculosa, penyebab lain: virus, toxoplasma gondhii,
ricketsia
Meningitis purulenta : cairan mengandung pus, penyebabnya antara
lain diplococcus pneumoniae, neisseria meningitidis, streptococcus
haemolyticus, staphylococcus aureus, haemophilus influenza,
pseudomonas aeruginosa
Kapita Selekta
Meningitis TB
Meningitis TB-Diagnosis
Tuberculous meningitis (TBM) is an inflammation of the meninges covering the
brain and spinal cord caused by infection with mycobacteria, most usually
Mycobacterium tuberculosis.
The condition usually presents with headache, fever, and convulsions and is
diagnosed clinically, with confirmation by microscopy and culture of
cerebrospinal fluid.
CSF Examination
Usually lymphocytic pleocytosis
Paradoxic change from lymphocytic to neutrophilic predominance over
48 hr pathognomonic for TB meningitis
Elevated protein with severely depressed glucose
Repeated specimens for AFB culture necessary
Other Studies
Brain imaging demonstrates hydrocephalus, basilar exudates and
inflammation, tuberculoma, cerebral edema, cerebral infarction
CXR
Abnormal, sometimes miliary pattern
Treatment

CSF Findings in Meningitis
71. EPILEPSI
A seizure is defined by release of excessive and
uncontrolled electrical activity in the brain. Seizures
themselves are not a disease, they are an event.
Epilepsy (seizure disorder) is a neurological condition,
that in different times produce brief disturbances in the
electrical functions of the brain. Seizures are a symptom
of epilepsy.
Epilepsy - Classification
Focal seizures account for 80%
of adult epilepsies
- Simple partial seizures
- Complex partial seizures
- Partial seizures secondarilly
generalised


Generalised seizures

Unclassified seizures
Partial Seizure
Simple
Seizure activity in the brain causing:
Rhythmic movements -
isolated twitching of arms, face, legs
Sensory symptoms -
tingling, weakness, sounds, smells,
tastes, feeling of upset stomach,
visual distortions
Psychic symptoms -
dj vu, hallucinations, feelings of
fear or anxiety
Usually last less than one minute
May precede a generalized seizure
Complex
Characterized by altered
awareness
Confusion, inability to respond
Automatic, purposeless behaviors
such as picking at clothes,
chewing or mumbling.
Emotional outbursts
May be confused with:
Drunkenness or drug use
Willful belligerence,
aggressiveness

GENERALIZED SEIZURES
INVOLVE WIDE AREAS OF THE BRAIN AND LOSS OF
CONSCIOUSNESS
PETIT MAL : CONSCIOUSNESS IS TRANSIENTLY LOST AND
THE EEG DISPLAYS SPIKE AND WAVE ACTIVITY
GRAND MAL : CONSCIOUSNESS LOST FOR A LONGER
PERIOD AND THE INDIVIDUAL WILL FALL IF STANDING
WHEN SEIZURE STARTS.
TONIC PHASE: GENERALIZED INCREASED MUSCLE
TONE.
CLONIC PHASE: SERIES OF JERKY MOVEMENTS.
BOWEL AND BLADDER MAY EVACUATE.

Epilepsi-Klasifikasi (etiologi)
Idiopatik epilepsi : biasanya berupa epilepsi dengan serangan kejang
umum, penyebabnya tidak diketahui. Pasien dengan idiopatik epilepsi
mempunyai inteligensi normal dan hasil pemeriksaan juga normal dan
umumnya predisposisi genetik.
Kriptogenik epilepsi : Dianggap simptomatik tapi penyebabnya belum
diketahui. Kebanyakan lokasi yang berhubungan dengan epilepsi tanpa
disertai lesi yang mendasari atau lesi di otak tidak diketahui. Termasuk
disini adalah sindroma West, Sindroma Lennox Gastaut dan epilepsi
mioklonik. Gambaran klinis berupa ensefalopati difus.
Simptomatik epilepsi : Pada simptomatik terdapat lesi struktural di otak
yang mendasari, contohnya oleh karena sekunder dari trauma kepala,
infeksi susunan saraf pusat, kelainan kongenital, proses desak ruang di
otak, gangguan pembuluh darah diotak, toksik (alkohol, obat),
gangguan metabolik dan kelainan neurodegeneratif.

Diagnosis Epilepsi Lengkap-Perdossi
72. PARESE N. VII
Menurut Penyebab Stroke dibagi :
1. Stroke Hemoragik
a. Intra cerebral hemoragik (ICH)
OK : Hypertensi, Aneurysma dan arterioveneus Malformasi (AVM)
b. Sub Arachnoid Hemoragik (SAH)
diagnosis medis : CT brain scan
2. Stroke Non Hemoragik (Iskemik)
OK : Arteriosklerosis & sering dikaitkan dengan : DM,
Hypercolesterolemia, Asam urat, hyperagregasi trombosit
3. Emboli Sumber dari tronkus di arteria carotis communis di jantung
Lepas trombus embolus otak.
73. STROKE
Tatalaksana Khusus
Stroke Hemoragik :
Perawatan di ICU jika didapatkan volume hematoma lebih dari 30 cc,
perdarahan intraventrikuler dengan hidrosefalus dan klinis cenderung
memburuk,
Tekanan darah diturunkan sampai tekanan darah premorbid atau
sebanyak 15-20% bila tekanan sistolik >180, diastolik >120, MAP >130, dan
volume hematoma bertambah.
Bila terdapat gagal jantung maka tekanan darah segera diturunkan
dengan labetolol intravena dengan dosis 10 mg (pemberian dalam 2
menit) sampai 20 mg (pemberian dalam 10 menit) maksimum 300 mg;
enelapril intravena 0,625-1.25 mg per 6 jam; Captopril 3 kali 6,25-25 mg
peroral,
Jika didapatkan tanda-tanda tekanan intra kranial meningkat, maka posisi
kepala dinaikkan 30 derajat, dengan posisi kepala dan dada pada satu
bidang, bisa dilakukan pemberian manitol (lihat stroke iskemik), dan
hiperventilasi (PCO2 20-35 mmHg),

Kapita Selekta Kedokteran
74. CRANIAL NERVES
75. VERTIGO
the illusion that the environment is
spinning
a subtype of dizziness, where there is a
feeling of motion when one is
stationery
Classification :
Peripheral
Central
Common Causes:
1.Peripheral
Physiological (motion sickness)
Benign paroxysmal positional vertigo
(BPPV) most common
Vestibular neuronitis
Labyrinthitis
Menire disease
Perilymph fistula
2.Central
Brainstem TIA/infarct
Posterior fossa tumors
Multiple sclerosis
Syringobulbia
Arnold - Chiari deformity
Temporal lobe epilepsy
Basilar migraine
3.OtherCardiac, GI, psycogen, toxins, medications,
anemia, hypotension
Vertigo
Peripheral vertigo : caused by
problems within the inner
ear/vestibular system; also
called otologic or vestibular
vertigo.
The most common cause :
BPPV (32%)

Central vertigo : arises from
injury to the balance centers
of the CNS; less prominent
movement illusion and
nausea.
Has accompanying neurologic
deficits (e.g. slurred speech
and double vision), and
pathologic nystagmus (pure
vertical/ torsional)
BPPV A clinical syndrome characterized by brief recurrent
episodes of vertigo triggered by changes in head position
with respect to gravity.
Meniere disease An inner ear disorder that causes one to experience
periods of vertigo, dizziness, nausea, ear pressure,
sensitivity to light and tinnitus
Migraine with aura Suatu kondisi kronis dengan karakteristik sakit kepala
episodik unilateral yang didahului dengan gejala aura
(gangguan visual, sensasi abnormal pada kulit, mual,
muntah, dll)
76. PARKINSON
DISEASE
Parkinson Disease : a degenerative disorder of the central
nervous system.
The motor symptoms of Parkinson's disease result from
the death of dopamine-generating cells in the substantia
nigra, a region of the midbrain; the cause of this cell death
is unknown.
3 main symptoms:
Tremors
Rigidity
Slowed motion (Bradykinesia)
Other symptoms include:
Dementia, sleep disturbances, depression, etc.

Parkinson Disease
No definitive tests for PD. PET scans can aid to determine levels of
dopamine.
Medical history and neurological tests are conducted to diagnose.
Usually, if two of the cardinal symptoms are present
Treatment can be divided into two stages.
Early and Later stages
Early stage
Onset of symptoms, treated with physical therapy and medications
(Levodopa, dopamine agonists, etc)
Later stage
Usually after having received 5+ years of levodopa treatment.
Wearing-off and On/Off effect develops, other medication in
conjunction levodopa is commenced.
MAO-B and COMT inhibitors.
73
Treatment Physical Therapy
Regular exercise
Recommended throughout the life of disorder.
Helps maintain and improve mobility and strength.
Physical exercise aids in rigidity relief, muscle strength and
flexibility, balance, etc.
Caution is advised to avoid sudden movements or strenuous
activities fall could result in serious injury.

74
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