aftermid_trauma susunan saraf.ppt
TRANSCRIPT
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TRAUMA SUSUNAN SARAF
O S HARTANTO
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TRAUMA SUSUNAN SARAF
• Trauma capitis: 26% kecelakaan yg >1 hari tak kerja
• Trauma capitis: 33% penyebab kmatian krn.kecelakaan
• Trauma capitis: 50% K.L.L• Kecelakaan → 40-50% mati sblm di RS R.S. → 40% mati dlm 1 hari → 35% mati dlm 1 minggu
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Trauma susunan saraf• Kematian/cacat krn trauma 50% trauma langsung 50% ggn.peredaran darah• Trauma capitis > trauma tl.belakang• Kepala yg dipukul tempat yg langsung kena impact/dampak• Dampak: indentasi fracture linear fracture stelatum fracture impresi tidak apa2
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• Trauma capitis:1 pingsan sejenak (tak ada kelainan)
2 pingsan bbrp jam (organic brain syndrome) 3 pingsan lama, sadar, defisit neurologis 4 meninggal
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Komotio cerebri
• Pingsan sejenak ± amnesia retrograd• Tanda kelainan neurologis (-)• Kesadaran ditentukan difuse ascending
reticulum system• Akselerasi →gerak cepat& mendadak• Peregangan poros batang otak→
menimbulkan blokade reversibel• blokade→ otak tidak mendapat input
aferen→pingsan
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Trauma kapitis→ kelainan neurologis• Kontusio cerebri• Laserasio cerebri• Hemoragi subdural• Hemoragi epidural• Hemoragi intracerebral
Tekanan intrakranial• Tekanan dlm tengkorak tak blh berubah• T.I.K→konstante misal: oedem cerebri(TIK ↑↑ )diimbangi dengan
pengurangan darah & LCS→ TIK normal
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• Pukulan yg keras→ identasi 5 msecond → osilasi (naik turun) ¾ kali→ rata
kembali
• Tekanan positif/negatif bergantian tekanan positif → kompresi tekanan negatif → cavitas
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• AKSELERASI: gerakan cepat & mendadak
• De akselerasi: penghentian akselerasi• Akselerasi : penggeseran otak ke dampak penggeseran otak ke arah berlawanan• Dampak oksiput lesi kontusio coup →seberang tak ada
kompresi lesi kontra coup →ada kompresi
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• Akselerasi: linear rotatorik• Akselerasi & deakselerasi rotatorik &
linear bisa memutuskan vena2 antara dura & arachnoid
• Perdarahan subdural→ bridging vein terputus
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Contusio cerebri• Akselerasi kepala →kompresi, destruktif → pergeseran otak Hiperekstensi → peregangan otak thdp batang otak → blokade irreversibel ascendens reticularis difus• Lesi contusio coup/ contracoup/ intermediate
→defisit neurologis• Setelah sadar → organic brain syndrome
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• Autoregulasi: pemb.darah terganggu → tek.darah ↓ , nadi cepat →ggn.pusat vegetatif: mual, muntah, ggn.pernafasan
• Kontusio berat → mati krn.ganguan cardiopulmoner
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Perdarahan subdural (SDH)
• Sering pada bag.lateral& atas hemisfer dan temporal
• Yg terkena bridging veins• Vena 100cc-200cc darah• Perdarahan berhenti krn tamponade 5-7 hari
reorganisasi 10-20 hari• Perdarahan kecil hygroma• Keluhan SDH : timbul segera atau jauh setelah trauma
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• Keluhan SDH : timbul segera atau jauh setelah trauma latent interval: masa tanpa keluhan bisa minggu,
bulan, atau tahun gejala: pusing manifestasi hematom subdural: bila ada gejala SOP -.hemiparesis - kesadaran - epilepsi fokal - hemihipaesteshi - papil edema
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Perdarahan intracerebral (ICH)
• Sering di lobus temporalis & frontalis• Perdarahan kecil• Bila penderita ICH → survive →gliosis & cavitasi• Gejala neurologis sesuai dgn topik
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PERDARAHAN EPIDURAL (EDH)
• Bila EDH tanpa fraktur tengkorak → TIK cepat meningkat• Jika terbuka, darah akan keluar, TIK tak cepat ↑• Yg pecah arteri/vena? bila arteri→ TIK↑ dlm 1 jam Kompresi cerebral traumatik akut kesadaran menurun progresif pupil dilatasi pada sisi lesi pernafasan mencerminkan disfungsi rostrocaudal hemiparesis, epilepsi focal
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TRAUMA MEDULA SPINALIS• Fraktur• Dislokasi• Fraktur : bag.corpus vertebralis• Dislokasi : C1.2 C5.6 Th 11.12• Trauma indirek whiplash, jatuh terduduk• Lesi di medula spinalis Laserasio MS Hemato mieli kompresi medula spinalis Rheksis C5.7
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Trauma non mekanik
• Radiasi radionekrosis akut radionekrosis laun• Gaya elektrik• Gaya termik• Trauma suara• Dekompressi atmosfer akut caisson disease
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Terima kasih