Diffuse Axonal Injury dan Temuannya

Susilo; Liauw Djai Yen; Rennie Yolanda; Sheilla Dewi; Samantha Shania; Billy Leoprayogo; Geraldo Vivaldi; Janeta Odelia

doi:10.36452/jkdoktmeditek.v28i1.2124

Authors

Susilo Departemen Neurologi, Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Kristen Krida Wacana , Jakarta, Indonesia
Liauw Djai Yen Departemen Forensik dan Medikolegal, Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Kristen, Krida Wacana, Jakarta, Indonesia
Rennie Yolanda Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Katolik Indonesia Atma JayaFakultas Kedokteran dan Ilmu Kesehatan, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia.
Sheilla Dewi Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia.
Samantha Shania Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia.
Billy Leoprayogo Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia.
Geraldo Vivaldi Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia.
Janeta Odelia Fakultas Kedokteran dan Ilmu Kesehatan, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia.

DOI:

https://doi.org/10.36452/jkdoktmeditek.v28i1.2124

Keywords:

cedera aksonal difus, klinis, otopsi

Abstract

Diffuse axonal injury (DAI) adalah cedera mikroskopis yang terjadi di akson pada substansia alba di traktus neuron otak, korpus kalosum, dan batang otak. Biasanya keadaan ini ditandai dengan koma setelah cedera kepala traumatis yang menyebabkan edema dan iskemia pada otak. Keadaan ini sering berujung pada morbiditas maupun mortalitas. Penyebab tersering DAI adalah kecelakaan lalu lintas kendaraan roda dua dengan kecepatan tinggi. Pasien DAI dengan nilai Glasgow Coma Scale (GCS) yang rendah sering dihubungkan dengan faktor prognostik buruk yang berhubungan dengan mortalitas. Diagnosis klinis DAI dapat dibuat berdasarkan visualisasi radiologis, namun diagnosis pasti baru dapat ditegakkan dengan pemeriksaan jaringan post mortem. Pada pemeriksaan makroskopis akan ditemukan gambaran hemoragik pada substansia alba, namun pada autopsi biasanya gambaran tersebut sudah menyusut dan meninggalkan gambaran lesi berwarna cokelat, selanjutnya pada kerusakan yang sudah lama dapat menyebabkan penyusutan volume otak. Ciri kerusakan pada DAI dibedakan menjadi tiga, yaitu kerusakan supratentorial difus pada akson (derajat I), lesi fokal di korpus kalosum (derajat II), dan lesi pada rostral batang otak (derajat III). Pada pemeriksaan mikroskopis tahap awal dapat muncul gambaran "axonal bulb" yang selanjutnya berubah menjadi gambaran aksonal negatif seiring berjalannya waktu.

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