INFEKSI

SUSUNAN
INFEKSI
SARAF PUSAT
SUSUNAN
SARAF PUSAT

dr. Mohammad Syarif

Dr. Moch. Bahrudin, SpS

dr.Moch.Bahrudin,SpS 8/2/2018 1
MENINGEN (SELAPUT OTAK)

The meninges are layers

of tissue that separate the
skull and the brain.

Skull
Dura mater

Arachnoid Layer
Pia Mater
Brain
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The Ventricles
The ventricles are a complex
series of spaces and tunnels
through the center of the brain.
The ventricles secrete
cerebrospinal fluid, which
suspends the brain in the
skull.
The ventricles also provide a
route for chemical messengers
that are widely distributed
through the central nervous
system.

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 Ventricles
 Expansions of brain’s central cavity
 Lined with Ependymal Cells
 Filled with CSF (cerebrospinal fluid)
 Ventricles continuous w/each other + central canal of spinal cord

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Cerebrospinal Fluid

Cerebrospinal fluid is a colorless

liquid that bathes the brain and
spine.
It is formed within the ventricles of
the brain, and it circulates
throughout the central nervous
system.
Cerebrospinal fluid fills the
ventricles and meninges, allowing
the brain to “float” within the skull.

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Flow of CSF
 Formed in Choroid plexuses
 Through Ventricles
 Into Subarachnoid space & central canal
from 4th ventricle
 Through Arachnoid Villi into Superior
Sagittal Sinus
 Into Internal Jugular Vein

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What is meningitis?

• Meningitis is an infection of the sheaths that cover the brain

and spinal cord.
 Meningitis is usually caused by an infection with a virus, with a
bacterium or even with fungi.
 MENINGO ENCEPHALITIS

Def. : adalah infeksi pada selaput otak dan

jaringan otak

Etiologi :
•Protozoa : toksoplasmosis , malaria
•Bakteri : Kokus, TBC
•Mikosis : Blastomikosis ,dll
•Riketsia
•Virus

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PATOGENESA & PATOFISIOLOGI

Melalui :
- Hematogen
- Fokus dekat dengan kepala (sinusitis)
- Trauma capitis (Fr. Terbuka)
- Faring (virus)

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GEJALA KLINIS

SAKIT KEPALA
PANAS
KAKU KUDUK
MUNTAH
NAPSU MAKAN MENURUN
KESADARAN MENURUN
KEJANG

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 PEMERIKSAAN LIQUOR
DX Color Opening RBC WBC Gluc Prot Smear Cx
Pressure
Viral Normal Normal 0 100- 45-85 Normal Neg Neg
or 1000 or
elevated mostly elevated
mono’s
Funga Normal Normal 0 100- < 45 > 50 Fungal +/-
l or or 1000 smear
cloudy elevated mostly positive
mono’s
TB Normal Elevated 0 100- < 45 > 50 AFB +/-
or 1000 positive
cloudy mostly
mono’s
BAKTERI cloudy Elevated 0 > 10000 < 45 > 50
mostly
poly

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PENANGANAN MENINGO ENCEPHALITIS

1. UMUM : 5B

2. KHUSUS : SESUAI DENGAN PENYEBAB

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MENINGITIS BAKTERIAL AKUT
PURULENTA

ETIOLOGI :
KOKUS (STREPTOKOKUS, Staphilokokus,
Pneumokokus, Meningokokus )
Hemofilus influensa

EPIDEMIOLOGI
Insidens : AS 3- 5 / 100.000 pddk/ th
Faktor resiko : malnutrisi, immun 
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 Differential Dx
Viral - 40 % of meningitis
Fungal
Tuberculous
Spirochete
Chemical / Drug induced
Collagen Vascular Disease
Parameningeal infection: brain abscess,
epidural abscess
Subarachnoid hemorrhage
Neuroleptic Malignant Syndrome

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Gejala Klinis :
Akut
Sakit kepala hebat
Muntah
Panas tinggi
Fokal (kejang, kesadaran )

Pemeriksaan Neurologis
 Meningeal Sign + (KK, Kernig, BZ I-IV)
 Gangguan Saraf otak
 CSS : LEKO ↑ (PMN) , GLUK ↓, PROT ↑,
KULTUR.

LAIN-LAIN : X-FO, KULTUR DRH, CT Scan

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Meningitis Bakteri
 LSS :
 Tekanan ↑
 Sel ↑ (PMN)
 Protein ↑
 Glukosa ↓
 Pengecatan gram : Coccus
 Kultur : Pertumbuhan kuman
 Komplikasi :
 Arachnoiditis → gangguan
reabsorbsi LSS → hidrosefalus
 Abses otak

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PENATALAKSANAAN

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TERAPI EMPIRIS

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PROGNOSA

• UMUR PX
• JENIS BAKTERI CSS
• KESADARAN MRS
• DX DAN TX
• DEFISIT FOKAL

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Meningitis TBC
 Disebabkan Mycobacterium tuberculosa

 Gejala klinis :
 Terjadinya subakut
 Nyeri kepala
 Mual
 Kejang
 Kesadaran menurun

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Meningitis TBC
 Pemeriksaan neurologis :
 Meningeal sign (+)
 Gangguan saraf otak
 Fundus okuli : choroid tubercle
 LCS :
 Tekanan ↑
 Sel ↑ (MN)
 Protein ↑
 Glukosa ↓
 Pelicle (liquor dibiarkan semalam) →
sarang laba-laba

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Meningitis TBC
 Gejala klinis : 4 fase
I. - Meningeal sign (+)
- Sadar
- Saraf otak normal
II. - Meningeal sign ++
- Sadar
- Saraf otak terganggu (VI, VII)
- hemiparesis (arteritis)
III. - Meningeal sign ++
- Kesadaran menurun
- Gangguan saraf otak
- Kejang
IV. Idem III + Koma + Shock

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Meningitis TBC
 Terapi :
 INH 400 mg/hari
 Streptomycin 1 gr/hari im
 Rifampicin 600 mg/hari
 Pirazinamid 20 mg/kb BB/hr (± 1 gram/hari)
 Sampai sel LSS normal  diteruskan INH
selama 1,5 tahun

 Ethambutol tidak diberikan, karena

menyebabkan ATROPI N. OPTIKUS

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Meningitis TBC
 KOMPLIKASI = purulenta
 PROGNOSIS : tergantung
 Umur < 3 tahun/>60 tahun : BURUK
 Diagnosa dini : baik
 Fase I  sembuh
 Fase III/IV  sembuh cacat

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Meningitis Luetika
 Lues stadium II
Beberapa hari/mgg setelah infeksi primer
 Stadium III (sifilis meningobakteri)
beberapa tahun setelah infeksi primer (± 3
tahun)

GEJALA KLINIS :
 Sakit kepala ringan
 Sel ↑ (MN < 500/mm3)
 Protein ↑
 Glukosa normal
 VDRL/TPHA (+)

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Meningitis Luetika
 TERAPI :
 Penicillin 1 juta IU/hari sampai liquor
baik

 BENTUK INFEKSI SIFILIS :

1. Demensia paralitika
2. Tabes dorsalis

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