neurologi 12

8/19/2019 neurologi 12

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Ilmu Penyakit SarafDr. Sri Harso M.kes Sp.S

GCS• E

• Spontaneous................ 4

• To Speech.................... 3

• To pain....................... 2

• Nil............................... 1

• M

• Obeys........................... 6

• Localized...................... 5

• Withdraws.................. 4

• Flexion (decorticate) … 3

• Extension (decerebrate). 2

• Nil.................................. 1

• V

• Oriented......................... 5

• Confused conversation .... 4

• Inappropriate words....... 3

• Incomprehensible sound .. 2

• Nil............................... 1


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Stroke

is a neurological impairment caused by adisruption in blood supply to a region of the brain.


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Shiriraj skore

Iskemik


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Stroke hemorrahage

ICH

SAH

INTRA CEREBRAL HEMORRAHAGE


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SUB ARACHNOID HEMORRAHAGE

*KAKU KUDUK

*ANEURISMA(AVM)

*THUNDERCLA P HEADEACHE

*MENINGEALIRRITATION

*VOMITUS

PERBEDAAN SH & SNH


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TROMBOLITIK

• Onset < 3 jam – jika diberikan segera outcomelebih baik

• Stroke onset = dari saat terakhir tampak normal

• Jangan diberikan jika glukosa darah185/110

• Risiko kecacatan 30% walaupun 5% risikoICHsimtomatik

< 3 jam 1. Merupakan batas mutlak2. Tidak ada batasan luas lesi3. Dapat diberikan pada pasien ygs ebelumnya

riwayat penggunaan warfarin dan INR 80 tahun• •NIHSS > 25 • •DM, riwayat stroke sebelumnya• •Riwayat pemakaian warfarin


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Anti trombotik


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Antihipertensi pada Stroke Iskemik Akut

• target penurunan sekitar 15%

• Diberikan apabila TDS >220 atau TDD >120

Pada yang akan diberi terapi trombolitik:1. Target TDS


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SECONDARY PREVENTION

Prevention Life style Modification

Blood Pressure Lowering

•Semua pasien stroke/TIA mendapat obat antihipertensikecuali terdapat symptomatic hypotension

Antiplatelet Therapy

Long-term antiplatelet therapy diberikan pada semua penderitastroke iskemik/TIA yang tidak mendapat terapi antikoagulan•Dapat diberikan Aspirin+dipyridamole(atau aspirin saja pada pasien yang alergi dipyridamole) ATAU Clopidogrel

Anticoagulation Therapy

Diberikan pada penderita stroke iskemik/TIA yang memiliki atrial fibrilation/cardioembolic stroke

Cholesterol lowering


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BELL’S PALSY

PERIFER VS CENTRAL

PERIFER CENTRAL

Atas bawah

Ipsilateral

Bawah

Contralateral


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Grand Mal


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Antiepileptic Drugs


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TREATMENT RECOMMENDATION


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Cerebrospinal Fluid


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• paroxysmal attacks of severe,short, sharp, stabbing pain→affecting one or moredivisions of the trigeminal nerve

Precipitated by : chewing,speaking, washing the face, tooth- brushing, cold winds, or touchinga specific “trigger spot”(e.g. Upperlip or gum)

Etiology :• Many remains unexplained• Compression of the nerve root

• by tumors of thecerebellopontine angle

• Demyelination

Trigeminal Neuralgia

Investigation : •CT/MRI to exclude a cerebello-pontine anglelesion

Management : •Carbamazepine (600-1600mg/day)•Nerve block •Trigeminal ganglion/root injection withalcohol/phenol•Microvascular decompression•Radiofrequency thermocoagulation


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migrain


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Migrain

Cluster Headache


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Lewy body• Lewy bodies are concentric, eosino philiccyto

plasmicin clusions (SCI) with peripheral halosand dense cores.

• Present within pigmented neurons of substantianigra.

• Characteristic of PD but not pathognomonic


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Inbalance

between

Dopamine

vsAcetylcholine


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Agents that Increase Dopamine

functions• Increasing the synthesis of dopamine -l-Dopa • Inhibiting the catabolism of dopamine (MAO-B

Inhibitor)-selegiline • Stimulating the release of dopamine -

amphetamine • Stimulating the dopamine receptor sites

directly(Dopamin agonist)- bromocriptine&pramipexole

• Blocking the uptake and enhancing the release ofdopamine -amantadine


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anopsia


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Myastenia Gravis

VERTIGO: Perifer vs Sentral


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DIX-HALLPIKE MANEUVER

EPLEY


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Reclined head hanging 45 degree turn

Rotate 45 degrees contralateral


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Head and body rotated to 135degrees from supine

Keep head turn and to sittingTurn forward chin down 20 degrees


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BRANDT & DAROFFEXCERCISES


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Medikamentosa

Calcium Channel Blocker

Antihistamin

Histaminik

Mengurangi aktivitas ekstatori SSP dengan menekan pelepasanglutamat, meningkatkan aktivitas NMDA sepcific channel, dan bekerja langsung sebagai depressor labirin. Bisa untuk vertigoperifer dan sentral.

Efek antikolinergik dan merangsan inhibitory-monoaminergik,dengan akibat inhibisi n. Vestibularis

Inhibisi neuron polisinaptik pada n.vestibularis lateralis


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HNP

dermatom


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laminectomy


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Plexus Brachialis


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• Superior Trunk (C5-C6)Injury:

• Antaraleherdgnbahuteregang→Erb-DuchennePalsy(Waiter’s Tip)

• → Paralisism. deltoid, biceps, brachialis,danbrachioradialis.

• → Adduksibahu, rotasimediallengan, danekstensisiku.Parestesialateral upper limb .

• Inferior Trunk (C8-T1) Injury:

Tarikanmendadak dankerasupper limb→ KlumpkePalsy→Claw hand


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• The most common focal

peripheral neuropathy,results from compression ofthe median nerve at the wrist.Clinical Features:

1. Pain2. Numbness3. Tingling4. Symptoms are usually worse

at night and can awaken

patients from sleep.5. To relieve the symptoms,

patients often “flick”their wrist as if shaking down athermometer (flick sign).

CARPAL TUNNEL SYNDROME

• Phalen’s maneuver (fleksi tangan secara maksimal

dalam 60 detik timbul gejala→CTS +)• Tinel’s sign (posisi tangan sedikit dorsofleksi perkusi

carpal tunnel parestesia atau nyeri pada daerahdistribusi nervus medianus +)


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• nerve conduction study (NCS) is a medicaldiagnostic test commonly used to evaluate thefunction, especially the ability ofelectrical conduction,

of the motor and sensory nerves of the human body.

• nerve conduction study (NCS)


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Nice to know


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neurologi 12