ANATOMY OF CENTRAL NERVOUS

SYSTEM
ANATOMY OF CEREBRUM
ANATOMY OF CEREBRUM
ANATOMY OF CEREBRUM
ANATOMY OF CEREBRUM
 Tengkorak dan CNS

1.Foto standart projection

a.Foto PA & Lateral
b.Townes utk fossa
pos.
c.Basis, utk lihat
basis cr.
. 2. CT Scan
Tengkorak dpt dilihat dg. 3. Arteriografi
4. Nuclear scintigrafi
5. Ultrasonografi
6 . MRI
 Sella Tursica

Normal :
a a = 11 - 16 mm
b = 8 - 12 mm
b Sella tursica, pada or. dewasa bbtk
kantung.
Kelainan-2 : Small sella- myotonia cong
J-shape//shoe/hour glass seperti
pada gambar spt berikut
Sella Tursica
CRANIAL SUTURES
FONTANELLE
SKULL X-RAY AP
SKULL X-RAY AP
SKULL X-RAY LATERAL
Sutura digunakan utuk melihat tekanan intra cranial.

Yang dilihat Fontanella

Fontanella mayor Fontanella minor

menutup 3 - 6 bln menutup 15 - 18 bln
 Kalsifikasi Normal Intrakranial.

1. Kelenjar Pineal, ukuran 3 - 5 mm

2. Commisura Habenulare, terltk dianterior kel. Pineal,dibgn blkng
ventr.III -- simetris.
3. Plexus choroideus, bbtk punctate, simetris =s/d 1cm di glomus dan
bilateral.
4. Kalsifikasi di duramater, di falx cerebri atau ditepi dekat tlng.
5. Ligamentum petroclinoid = jembatan antara proc.ant & post sella
6. Paccionian bodies
7. Kel. Pituatary
8. Basal ganglia dan nucleus dentatus
9. Lensa mata.
Kalsifikasi Normal
 Gambaran Skull abnormal dengan kepala kecil

Turri cephali Brachi cephali Dolicho cephali

pntpan bgn blkng pntpn bgn lateral pntpn bgn depan
Macam-macam btk cranium
 Macam-macam kelainannya.

1. Craniostenosis bisa berupa :

a. Trigonocephali (metopic sutura)
b. Scaphocephali (sagital sutura)
c. Plagiocephali (pd lambdoid dan coronal sutura)
d. Microcephali (seluruh sutura menutup/immature)

2. Lacunar skull, pada calvaria tampak thumb print/ cetakan ibu jari
Pada anak-2 bisa krn craniostenosis

3. Platy basia, bentuk basis cranii mendatar, tdk tmpk fossa cranii ant, media
maup
un posterior.

4. Basillar impression fossa cranii posterior naik ke atas.

5. Hypertelorisme jarak orbita kanan & kiri yang lebar

6. Cranial meningocele/ encephalocele

 Kelainan pada jaringan otak

Crbral injuries CVA Degen.disease Inflam.

Tumor

Cerebral injuries :epidural bleeding, subdural bleeding,

hygroma, herniasi, perdrhn coup & contra coup

Cerebro vascular accident

Cerebral infarction Cerebral haemorrhage

 Hydrocephalus

penutupan bisa di

Foramen Monro Aquaduct Sylvii

Foramen Magendi

Pada orang dewasa tekanan intra cranial dapat dilihat dari :

processus clinoideus
ant.

Kelainan sella tursica processus clinoideus

post.

clivus
Hydrocephalus
A 65-year-old man presented with
progressive dementia. Sequential axial
noncontrast CT (NCCT) image
demonstrates a global pattern of cerebral
atrophy with prominent compensatory
ventriculomegaly. Note the diffuse
widening of the subarachnoid spaces over
the cerebral convexities and sylvian
fissures, which helps to distinguish
atrophy from obstructive hydrocephalus.
Axial T1-weighted MR image in an infant
of the malformation (solid arrow)
producing flow artifact across the midline
of the image (open arrows) and
hydrocephalus of the lateral ventricles
(arrowheads).
 Meningitis
Axial contrast-enhanced T1W MR
image in a neonate with group B
streptococcal meningitis shows
extensive leptomeningeal exudates at
the inferior frontal and anterior
temporal regions (arrows)

Axial contrast-enhanced T1W MR image

in a child with acute pyogenic meningitis
reveals enhancing leptomeningeal
exudates over bilateral cerebral
convexities (arrows).
Ukuran Kepala
 Degenerative disease

Cerebral atrophy Demyelinating

disease

Inflamation

Encephalitis Cerebral abscess Tuberculoma

Toxoplasma

Kelainan o.k virus Kelainan o.k.

parasit
Cerebral atrophy
Axial brain MRI of a patient with
progressive tremorless
parkinsonism and frontal-
predominant dementia (Mini
Mental State Examination = 23/30;
Frontal Assessment Battery =
10/18; abnormal clock drawing
task and additional constructional
impairment) with moderate
ideomotor apraxia. The MRI
demonstrates predominantly
frontal (A) and anterior temporal
atrophy (B) suggestive of
frontotemporal dementia.
Demyelinating disease

Axial proton densityweighted MRI

demonstrates multiple lesions in a
distribution characteristic of multiple
sclerosis. Specifically, the
periventricular lesions and the more
peripheral white matter lesions near
the gray matterwhite matter junction
are typical MRI findings in multiple
sclerosis.
Neoplasma :

1. Meningioma 5. Medulloblastoma

2. Astrocytoma 6. Neurinoma

3. Oligodendroglioma 7. Craniopharyngioma

4. Glioblastoma
Kelainan pada jaringan otak
Tumor otak
Kelainan pada jaringan otak
Tumor otak
 Meningioma (Brain)

Definition:
Meningothelial or arachnoidal cell
neoplasm usually attached to the
dura
Pilocytic Astrocytoma (Pediatric
Brain)

Cerebellar pilocytic
astrocytoma. Coronal T2-
weighted MR image shows both
the solid (hypointense) (arrows)
and cystic (hyperintense)
Medulloblastoma (Pediatric
Brain)

MRI of medulloblastoma. MRI of medulloblastoma.

Axial T2-weighted image Sagittal T1-weighted image
shows hypercellular shows hypointense mass in
mass with central cyst the fourth ventricle.
(arrow).
 ___________________ Trauma Kepala
Trauma Kepala
Merupakan penyebab utama kematian pada usia kurang dari 45
th. Dan penyebab kematian ketiga tertinggi pada populasi umumnya.
Foto Radiologi konvensional kini tergeser diganti oleh CT Scan,
bila tidak terdeteksi diganti oleh MRI. Ini terutama pada cedera
batang otak walaupun demikian foto polos cranium AP/Lateral masih
diperlukan pada keadaan cedera infratentorial karena pada CT Scan
ada Artefac dari tulang.

Kelainan yang ditemukan pada pasien dengan trauma kepala acut

dapat dibagi menjadi:
1. Fraktur kepala
a. Fraktur tulang tengkorak liniair, depresi, diastatik
b. Fraktur basis cranium
c. Fraktur Maxilofacial
___________________ Trauma Kepala

2. Cedera extra axial

a. Hematoma subdural
b. Hematoma epidural
c. Hematoma subarachnoid

3. Cedera Intra Axial

a. Diffuse Axonal Injury (Shear Injury)
b. Kontusio Kortikal
c. Hematoma Cerebral
d. Cedera Greymatter Subkortikal
e. Cedera batang otak primer

4. Cedera Sekunder
a. Sindroma Herniasi
b. Hydrocephalus
c. Perdarahan otak tengah Duret
d. Cedera Vaskuler dan kebocoran cairan otak.
___________________ Trauma Kepala
Fraktur Basis Kranium

1. Terdapat darah di balik membran timpani tanpa

trauma langsung telinga
2. Terdapat tanda Otorrhea atau Rhinorrhea Subcutan
di sekitar Processus Mastoideus (Battle Sign)
3. Terdapat Echimosis di sekitar Orbita tanpa adanya
trauma langsung pada Orbita (Raccoon Sign)
Cerebral Injury
 Sudural hematoma

Axial T1-weighted magnetic resonance

imaging demonstrates bilateral subacute
subdural hematomas with increased signal
intensity. Areas of intermediate intensity
represent more acute hemorrhage into the
subacute collections.

Subacute subdural hematoma with

extension into the anterior
interhemispheric cistern. Note that
the sutures do not contain the spread
of these hemorrhages.
 Epidural hematoma

Subdural hematoma with adjacent
subarachnoid hemorrhage was
the result of a ruptured middle
cerebral artery aneurysm.
Aneurysms are unusual causes of
Late subacute-to-chronic
subdural hematoma with a
blood-fluid level indicating acute
hemorrhage into the chronic
collection.
 Epidural Hematoma

CT scanning performed before

and after surgical evacuation
of an intracranial epidural
hematoma

This MRI demonstrates

spinal epidural hematoma.
 Intra cranial hemorrhage
This CT scan and MRI revealed midbrain
intracerebral hemorrhage (ICH) and
intraventricular hemorrhage (IVH) associated with
a cavernous angioma

Intracranial hemorrhage. CT scan of right

frontal intracerebral hemorrhage
complicating thrombolysis of an ischemic
stroke.
Kelainan pada jaringan otak
 Neuro Radiology of the Spine.
Pemeriksaannya bisa dengan :

1. Plain X-ray photo AP, Lateral atau Oblique

2. CT Scan

3. MRI

4. Myelography, caudography

5. Spinal angiography

6. Radio isotop scanning

7. USG
SPINAL CORD
 Bentukan abnormal dari spine :

A. Pada tulang B. Pada Discus inter.vert.

1.Kelainan congenital 1. Keradangan

2. Keradangan 2. HNP/
hernia nucleus
pulposus.
3. Tumor

4. Degenerative process

5. Trauma
 ______________________ SUMSUM TULANG BELAKANG

Sumsum Tulang Belakang

1. Tumor
2. Infeksi
3. Penyakit Degeneratif
4. Trauma
5. Metastase
 ________________________ MEDULA SPINALIS
Kelainannya berupa

1. HNP

2. Spinal canal stenosis, akibat degenerasi

canal stenosis,

3. Meningocele sering pada lumbal

(Dysrapsia)
4. Tumor:
a. Intramedullary
b. Intradural, misal meningioma,
neurofibrous, metastasis
c. Ekstradural, misal HNP, ekstradural
abses, retropeitoneal tumor,
ekstraspinal.
________________________________ H N P

Gambaran Myelografi Pada H.N.P

Pemeriksaan Myelografi
 Spondylolisthesis

Spondylolysis with Spondylolysis with Degenerative

spondylolisthesis. A lateral plain
film of the lumbosacral junction
confirms discontinuity of the
pars interarticularis at L5
(arrow) and a grade I
spondylolisthesis at L5-S1.
spondylolisthesis.
Sagittal T2-weighted image
discloses a grade 1
spondylolisthesis of L5 on
S1 and widening of the
anteroposterior dimension of
the spinal canal at that level.
spondylolisthesis.
Sagittal T2-weighted
scan shows a grade 1
spondylolisthesis of L4 on
L5 and hypertrophy of the
ligamentum flavum
posteriorly (arrows
Myelography
Myelography
Myelography
Myelography
Tumor pada medula spinalis
 Tumor metastasis

Spinal cord metastasis in a female patient known to have

breast cancer
 Tumor pada medula spinalis

Glioblastoma multiforme (GBM). Typical meningioma (white arrows)

Sagittal T2-weighted MR image of on sagittal T2-weighted MR image
the cervical spine demonstrates an presents as isointensity on T2-
extensive cervical thoracic weighted imaging
glioblastoma multiforme.