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Kuliah Umum Blok Saraf

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KULIAH UMUM BLOK SARAF

KULIAH UMUM BLOK SARAFRINI ANDRIANIBAGIAN ILMU PENYAKIT SARAF FK UNTARUMN DAN LMN

KELAINAN UPPER MOTOR NEURON :Vaskular, tumor, infeksi, trauma, degeneratif, metabolikKejangSakit kepala (cefalgia)KELAINAN LOWER MOTOR NEURON:Vaskular, tumor, infeksi/inflamasi, degeneratif, trauma, metabolik, obat2anGEJALA KLINISUPPER MOTOR NEURONKelumpuhan spastikNormotrofi atau atrofi krn disuseHipertonus Reflek fisiologis meningkatReflek patologis +Fasikulasi dan fibrilasi +

LOWER MOTOR NEURONKelumpuhan flacidNormotrofi atau atrofi

HipotonusReflek fisiologis menurunReflek patologis -Fasikulasi dan fibrilasi -

CEREBROVASCULAR DISEASEAny abnormality of the brain resulting from a pathologic process of blood vesselsarteries, arterioles, capillaries, veins, or sinuses. The pathologic change in the vessels takes the form of occlusion by thrombus or embolus, or of rupture.The resulting abnormalities in the brain are of two types: ischemia, with and without infarction, and hemorrhageCEREBROVASCULER DISEASEOther forms of cerebrovascular disease are those due to altered permeability of the vascular wall, hypertension, and increased viscosity or other changes in the quality of blood.

ISCHEMIC STROKETransient Ischemic Attacks (TIAs) : transitory neurologic defects due to ischemia in a particular angioanatomic territory, lasting for minutes to hours and followed by complete restoration of function. Embolic infarctionLacunar infarction

INTRACRANIAL HEMORRHAGESpontaneous Subarachnoid Haemorrhage due to Ruptured Saccular AneurysmPrimary Intracerebral HaemorrhageArteriovenous Malformation (AVM)Craniocerebral TraumaThe basic problem is both simple & complexsimple because there is usually no question about the cause and complex because of the abstruse nature of a number of secondary and delayed effects.PRIMARY INJURYSkull FracturesConcussion and Contusion Diffuse Axonal Injury Acute Epidural HaemorrhageAcute and Chronic Subdural HematomasPenetrating Injuries10SECONDARY INJURYHypoxia, hypotensionElevated intracranial pressure Hyperglycemia, Seizures Deep Venous Thrombosis and Pulmonary EmbolismHyperthermia, infection NEUROIMAGING

NEUROIMAGING

Intracranial NeoplasmsBenign or malignant(1) primary tumors (2) secondary tumors

Primary brain tumors

Pilocytic astrocytoma, grade I, Astrocytoma, grade IIAnaplastic astrocytoma, grade III, Glioblastoma multiforme, grade IV Oligodendroglioma, EpendymomaChoroid plexus papilloma, Neuronal tumors or mixed tumors (e.g., ganglioglioma)Embryonal tumors (medulloblastoma, PNET)Pineal parenchymal tumorsOther intracranial tumorsMetastatic tumors (breast and lung most common)Meningeal tumors (meningioma), Vascular tumors (hemangioblastomas), Pituitary adenomasGerm cell tumors (germinoma, teratoma)Primary CNS lymphoma, Nerve sheath tumors (vestibular schwannoma)Developmental tumors (craniopharyngioma, epidermoid, colloid cyst), Chondroid matrix tumors (chondrosarcoma, chordoma)

INFECTIONSInfections involving the nervous system carry a high morbidity and mortality, particularly in developing countries where the burden of disease is great, diagnosis is difficult and limitedresources mean that availability and access to treatment is poor.In the developed world, neurological infection is less frequent but continues to cause signifi cant problems of diagnosis and management.INFECTIONSInfections of the nervous system can be caused by viruses, bacteria, fungi or protozoa.They may affect the lining of the brain, CSF, brain parenchyma, spinal cord, nerve roots, peripheral nerve or muscle.

INFECTIONSMeningitis : inflammation involving the pia and arachnoid mater and the subarachnoid space. Encephalitis is infection and inflammation within the brain parenchyma. Focal infection causes abscess formation within or immediately adjacent to the brain or spinal cord.

INFECTIONSThese patterns may overlap and when infection involves the meninges, brain, spinal cord and nerve roots the descriptive compound terms are used: meningo-encephalitis, meningo-myelitis, encephalo-myelitis, meningo-radiculitis and meningo-encephalomyelitis.

EPILEPSYepilepsy is as a disorder of brain characterized by an ongoing liability to recurrent epileptic seizures. An epileptic seizure is transient clinical manifestations that result from an episode of epileptic neuronal activity. The epileptic neuronal activity is a specific dysfunction, characterized by abnormal synchronization, excessive excitation and/or inadequate inhibition, and can affect small or large neuronal populations.

CLINICAL SIGNSSudden and usually brief, include motor, psychic, autonomic and sensory phenomenon, with or without alteration in consciousness or awarenessthe symptoms depend on the part of the brain involved in the epileptic neuronal discharge, and the intensity of the discharge

Headache (CEPHALGIA)