Disorders of CNS

Al Munawir, M.D., M.S., Ph.D.

Department of Pathology
Jember School of Medicine.

CNS
2% body Wt but 20% Oxygen.
Hypoxia First to get affected.
Fluid tissue! Floats in CSF.
Very delicate, less support, BV
Limited space - Hard bony shell.
No regeneration Permanent cells.

Herniation - Trauma

Herniation - Trauma

Cerebral edema

Cerebrovascular disease
(Stroke)

Angka kematian berdasarkan

penyebabnya

Introduction:
Third leading cause of death.
Disease of brain due to lack of blood.
Atherosclerosis is the most common cause.
Clinically Stroke or CVS Acute onset of
focal neurologic deficit.
Ischemia & Infarction Liquifactive
necrosis. Healing leads to cystic spaces.

Types:
Slow Progress / Pale infarct:

Slow blockage, Liquifaction necrosis,

White/Pale infarct.

Rapid Progress / Red infarct

Sudden blockage, necrotic, hemorrhage.
Rupture of vessel

Edema, loss of demarcation:

Cerebral Infarct - 1 Week

Cerebral Infarct - 2 Weeks

Cerebral Infarction - Late

Subarachnoid Hemorrhage:

Intraventricular Hemorrhage:

Infarct with Punctate hemorrhage

Meningitis

Meningitis:
Inflammation of Meninges - Leptomeningitis
Meningoencephalitis Brain & meninges
Types:
Infective Septic & Aseptic (B, V, F & TB)
Chemical Drugs
Carcinomatous - metastasis

Headache + Neck stiffness. Neurological deficits

Complications: Encephalitis, Infarction,
Abscess, Hydrocephalus & empyema.

Septic Meningitis

Septic Meningitis

Septic Meningitis

Septic Meningitis-Microscopy

CSF-Examination
Cells

0-4
lympho

Protein

Glucose

0.1-0.4(n) 2.7-4.0 (n)

Appearance
Clear
colourless

Septic > Neutro

High

Low

Turbid

> Lymph

High

normal

Clear

Viral

Septic Meningitis-Spinal fluid

Brain Abscess:

Brain Abscess: CT Scan

Hydrocephalus:

Autopsy
Marked
inflammtory
infiltrate in
meninges
Superficial
Cerebral edema
(cortex)

Meningitis - Cryptococci
Round
capsulated
fungal organisms
Lymphocytic
infiltrate around

Summary:
Inflammation of Meninges.
Head ache, Neck stiff ness.
Septic & Aseptic types CSF diagnosis
Bacterial, viral, other.
Complications: Hydrocephalus.

CNS Tumors

Characteristics:
Limited space, more symptoms.
Vital structures, location determines
clinical features than the tumor itself.
Do not spread beyond Skull.
Neurons do not produce tumors.
Metastatic T. Glioma & Meningioma

Clinical features:
Local Compression & Infiltration
Nerve

& tract deficits, Paralysis, seizures

etc.

Raised Intracranial Pressure.

Headache,

vomiting, slow pulse,

papilloedema.

Meningioma:
Arise from meninges covering of brain.
capsulated, slow growing (Benign)
Effect by pressure.
No infiltration or metastasis (Benign).
Surgery.

Meningioma

Meningioma

Glioma:
Neoplasms of supporting glial cells.
Astrocytoma - Commonest in adults
Diffuse, no border,
Varying grades, slow to very rapid.
Difficult to treat.

Glioma Cerebrum

Glioma:

Glioma:

Cortical atrophy Alzheimers

Anencephaly:

Hydrocephaly:

Summary:
Very delicate & sensitive to hypoxia.
Limited space, vital & permanent structures
Vascular, infection, Neoplastic&
degeneration.
Stroke, Meningitis (septic/Aseptic)
Neoplasms: Meningioma, glioma.
Parkinsons disease & Alzheimers disease.