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Dept.Neyrosain FKK.UMJ.2010KEDARURATAN NEUROLOGI(Level Of Conciousness) Anwar Wardy WJuni 2013anwar wardy w

Dept.Neyrosain FKK.UMJ.2010

Anwar Wardy W.FKK.UMJ

Dept.Neyrosain FKK.UMJ.2010The General Principle For Managing Neurologic Emergencies

Principle I: (Kaidah I) Kerusakan sistem saraf tidak menyebabkan kematian organ yang disarafi. Jaringan dan fungsi diharapkan dapat diperbaiki.anwar wardy w



Dept.Neyrosain FKK.UMJ.2010Emergency SymptomsConfusion Drowsiness Difficulty speaking clearly Numbness in any part of the body One pupil that is larger than the other

anwar wardy w



Dept.Neyrosain FKK.UMJ.2010Focal brain dysfunction

Brain tumourVascular events (CVA)DemyelinationInfection, such as cerebral abcessFocal head injuryDiffuse brain dysfunctionInfection, such as meningitis or encephalitisEpilepsyHypoxia and hypercarbiaDrugs, poisoning and overdoses ( including alcohol)Metabolic/endocrine causes, such as diabetic coma, Hepatic or renal failure, Hypothyroidism, severe electrolyte disturbancesHypotension, or hypertensive crisisDiffuse head injurySubarachnoid haemorrhageHypothermia, hyperthermiaanwar wardy w



Dept.Neyrosain FKK.UMJ.2010Primary Events:Cell, Axonal atau Myelin (Transmisi terganggu) Penyebabnya: 1. Anoxia 7. Toxin/Infeksi 2. Intracranial Hemorrhage. 8. Metabolic 3. Ischemia 4. TRAUMA 5. Hypoglicemia 6. Tumorsanwar wardy w



TRAUMAConcussion Cerebral contusion Epidural hematoma Subdural hematoma/effusion Intracerebral hematomaDiffuse axonal injury anwar wardyFKK UMJ

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EPIDURAL HEMATOMAanwar wardyFKK UMJ

FKK UMJ


SUBDURAL HEMATOMAanwar wardyFKK UMJ

FKK UMJ


Dept.Neyrosain FKK.UMJ.2010Secondary Events Edema Cerebri TIK Obstruksi dari Liquor CS. Vasospasme Kegagalan Autoregulasi Kegagalan Collateral supply Gagal Jantung Gagal Nafas.

AnoxiaICHIschemiaTumorsTraumaanwar wardy w



Dept.Neyrosain FKK.UMJ.2010Principle II (Kaidah 2) Selalu memerlukan intubasi Agar pernapasan terjamin dan oksigenasi ke otak terjamin baik. Cegah terjadinya: 1. Coma hypoventilasi. 2. Hypoxia otak dan acidosis / hypercarbia. anwar wardy w



Dept.Neyrosain FKK.UMJ.2010Glasgow Coma Score Eye Opening (E) 4=Spontaneous 3=To voice 2=To pain 1=None Verbal Response (V) 5=Normal conversation 4=Disoriented conversation 3=Words, but not coherent Total = E+V+M 2=No words......only sounds 1=NoneMotor Response (M) 6=Normal 5=Localizes to pain 4=Withdraws to pain 3=Decorticate posture 2=Decerebrate 1=Noneanwar wardy w



Dept.Neyrosain FKK.UMJ.2010Principle III (Kaidah 3)Stop perdarahan (Stop the Bleeding)

PRINCIPLE iv ( Kaidah 4)

Sirkulasi peredaran daraf keotak dipertahankan.anwar wardy w



Dept.Neyrosain FKK.UMJ.2010Principle V (kaidah 5) Penyakit tersebut Struktural atau Non- Structural.

Biasanya dilakukan dengan pemeriksaan Rontgen / CT.Scan atau Suspect N-Struktural dengan LP. anwar wardy w



INFRATENTORIAL LESIONSBrainstem symptoms are often seen initially Sudden onset of coma Cranial nerve abnormalities Alteration of the respiratory pattern anwar wardyFKK UMJ

FKK UMJ


PROGRESSION OF MASS LESIONSanwar wardyFKK UMJ

FKK UMJ


TYPES OF BRAIN HERNIATIONSanwar wardyFKK UMJ1= subfalcine2 = uncus 3 = caudal displacement4 = cerebellar tonsils

FKK UMJ


HERNIATION SYNDROMES Tonsillar or Foramen Magnum Herniation Displacement of brainstem and cerebellar tonsils into the foramen magnumProgressive ALOC, hypertension, bradycardia and irregular respirations (Cushing Triad)Transtentorial herniation Displacement of medial aspect of temporal lobe into tentorial hiatus ALOC, ipsilaterial pupillary dilatation, contralateral hemiparesis Upward tentoral herniation Cerebellar vermis moves into incisura Produces brain stem compression

anwar wardyFKK UMJ

FKK UMJ


Dept.Neyrosain FKK.UMJ.2010Principle VI (Kaidah 6)

Diagnosis cepat dan sederhana (Simple & Spot Diagnosis) : yaitu dengan menggunakan pengetahuan Anatomi saraf (Topis Diagnostic) untuk mengetahui letak lesi di Otak.anwar wardy w




Herniation: The Brain Under Pressure

Bleeding or swelling in the brain can cause pressure that forces the brain downward in the skull.anwar wardy w



The ascending RAS, from the lower border of the pons to the ventromedial thalamusThe cells of origin of this system occupy a paramedian area in the brainstem THE STATE OF CONSCIOUSNESS (AROUSAL)


Dept.Neyrosain FKK.UMJ.2010Part I. Neurological Examination and Neurodiagnostic Testing 1. Neurological examination; 2. Neuroradiology; 3. Electroencephalography; 4. Lumbar puncture; 5. Electromyography; 6. Electronystagmography; 7. Evoked potentials; Main Diagnostic Supportanwar wardy w



Dept.Neyrosain FKK.UMJ.2010Part II. Common Neurological Presentations 8. Altered level of consciousness; 9. Headache; 10. Weakness; 11. Dizziness; 12. Seizures; 13. Gait disturbance; anwar wardy w



Dept.Neyrosain FKK.UMJ.2010Part III. Specific Neurological Conditions: 14. CNS infections in adults; 22. Dementia; 15. Viral encephalitis; 23. Neurooncology; 16. Vascular disease; 24. Neuropsychiatric 17. Movement disorders; 25.Neuroanesthesiology; 18. Neuromuscular disorders; 26. TIK 19. Musculoskeletal and neurogenic pain; 20. Neuroophthalmological disorders; 21. Multiple sclerosis; 28. Sleep disorders; 27. Normal pressure hydrocephalus; anwar wardy w



Dept.Neyrosain FKK.UMJ.2010Part IV. Neurological Trauma and Environmental Emergencies29. Traumatic brain injury; 30. Spinal cord injury; 31. Peripheral nerve injury; 32. Neurological complications of environmental emergencies anwar wardy w



Dept.Neyrosain FKK.UMJ.2010Part V. Pediatric Neurology 33. Hydrocephalus and shunts in children; 34. Pediatric CNS infections; 35. Pediatric stroke; 36. Pediatric seizures; 37. The hypotonic infant; anwar wardy w



Dept.Neyrosain FKK.UMJ.2010Part VI. Neurological Emergencies of Pregnancy: 38. Neurological emergencies of pregnancy; anwar wardy w



Dept.Neyrosain FKK.UMJ.2010Part VII. Brain Resuscitation and Neurotoxicology: 39. General neurotoxicology; 40. Neurotoxicology of alcohol and substances of abuse; 41. Brain resuscitation.anwar wardy w



Dept.Neyrosain FKK.UMJ.2010anwar wardy w



























Dept.Neyrosain FKK.UMJ.2010EvaluationICP monitoring is most often used in head trauma in the following situations:1) GCS less than 82) Drowsy with CT findings (operative or non operative)3) Post op hematoma evacuation4) High risk patients (a) Above 40 yrs. (b) Low BP (c) Those who require ventilation.There is nothing to achieve in monitoring ICP in the patients with GCS of less than 3.anwar wardy w









[email protected] 2008TERIMA KASIH,.Wassalam..//Bahan Bacaan:Gilroy John, Textbook Medical Neurology, MacMillan Publ. co.Inc. 5th Edition London, 2009. Surgery, and Internal Medicine, Neuroscience Intensive Care Unit, 2006.Epstein, Owen, Clinical Examination on Neurology Emergency, Mosby 2005

FKK.UMJ.Juni 2008

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