5/14/2012

TatalaksanaMeningitisTB
Dr.DarmaImranSp.S(K) DepNeurologiRSCMFKUI

TTL :Makassar,25April1967 INSTITUSI:DepartemenIlmuPenyakitSaraf FKUI/RSCM JABATAN:SPSProgramStudiIlmuPenyakit SarafFKUI2008 KetuaSubbagianNeuroinfeksi DepartemenNeurologiRSCM AsistenManagerPenelitian& PelatihanpadaUPTHIV/AIDS FKUI/RSCM

Dr.DarmaImran,SpS

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Topik
1. Lumbalpungsi 2. RegimenOATutkMeningitis

MeningitisTB(TBM)

TBM510%pasienTB MortalitasMTBdiRSCM
NonHIV35% HIV(+):60%

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HeinrichQuincke
Jerman18421922

Lumbalpungsiberulang (drainase)pasienanakyg komadandiagnosissbg meningitisinfantum PaskaLPkesadaranmembaik Awal:LPditujukansebagai terapi

1. QuinckeHI.Ueberhydrocephalus.VerhandlungdesCongressInnereMedizin (X),1891;32139. 2. WynterWE.Fourcasesoftubercularmeningitisinwhichparacentesiswas performedforthereliefoffluidpressure.Lancet1891;1:9812.

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LPHerniasi
Brainshift lanjut herniasi
LPdapatmemicuherniasiotak
PerburukanklinispaskaLPtdkselalukarena herniasi HerniasipaskaLPtdkselalukarenaLP

Herniasi
1. Peningkatantekananintrakranial 2. Herniasiotak(brainshift) Duakeadaanyangberbeda

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Brain shift

Brainshiftpada garistengah(falx cerebri) shiftkefossa posteriordari struktur supratentorial

shiftkeatas daristrukturdi infratentorial

LPBrainShift
LPtdkdikerjakanpdbrainshift LPdikerjakanpdTIKtinggi

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Mengenalbrainshift
Brainshift padagaris tengah(falx cerebri)

TandaKlinis Tandaimaging

shiftkeatas daristrukturdi infratentorial

shiftkefossa posteriordari struktur supratentorial

Klinisbrainshift
Sefalgiadanmuntah brainshifttentorium:kakukuduk,kesadaran menurun,hemiparesis,pupilanisokor Brainshiftforamenmagnum:kakukuduk, headtilt,kesadaranmenurun,bradikardi, apneu.
Papiledemawalaupunadabukanmerupakantandabrain shift

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Brainshift

Suprasella

ambient quadrigeminal
Normal JNNP1987;50:10711074 Shiftstruktur infratentorialkeatas

BahayaLP
LP:extremelyhelpfulandrarely dangerous?(JNeurol(2002)249:129137)

Contraindicationstolumbarpunctureare relativetotheimportanceofthedata beingsought.(Neurology1993;43;625)

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RegimenOATutkMeningitisTB
TBmeningitisyangmemilikimortalitas3060 %:menggunakanOATyangsamadenganTB paru. ImmunepathologyberbedadgnTBparu PenetrasiobatkeSSPberbedadgnjaringan lain.

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PenetrasiOATpdSSP

PenetrasiOATpdSSP

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RuslamidkkdiBandung: DosisTinggiRifampisinpdMeningitisTB
Patientsurvival(%)
100 80 60 40 20 0 0 50 100 150 200

days
SurvivalamongTBmeningitispatientstreatedwithhighdose()andstandarddose ()rifampicin(adjustedHR0.45,95%0.210.98).Onemonthmortalitywas 17%resp42%,sixmonthmortality34%resp61%.

Radiologicalfeatures:TBM

PaedInfectDisJ.2006;25(1):659

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Terimakasih
darma_imran@yahoo.com

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