Kuliah Umum Blok Saraf

KULIAH UMUM BLOK SARAF

RINI ANDRIANIBAGIAN ILMU PENYAKIT SARAF

FK UNTAR

UMN DAN LMN

KELAINAN UPPER MOTOR NEURON :-Vaskular, tumor, infeksi, trauma, degeneratif, metabolik-Kejang-Sakit kepala (cefalgia)

KELAINAN LOWER MOTOR NEURON:Vaskular, tumor, infeksi/inflamasi, degeneratif, trauma, metabolik, obat2an

GEJALA KLINIS

UPPER MOTOR NEURON• Kelumpuhan spastik• Normotrofi atau atrofi krn

disuse• Hipertonus • Reflek fisiologis meningkat• Reflek patologis +• Fasikulasi dan fibrilasi +

LOWER MOTOR NEURON• Kelumpuhan flacid• Normotrofi atau atrofi

• Hipotonus• Reflek fisiologis menurun• Reflek patologis -• Fasikulasi dan fibrilasi -

CEREBROVASCULAR DISEASE

• Any abnormality of the brain resulting from a pathologic process of blood vessels—arteries, 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 hemorrhage

CEREBROVASCULER DISEASE

• Other 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 STROKE

• Transient 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 infarction• Lacunar infarction

INTRACRANIAL HEMORRHAGE

• Spontaneous Subarachnoid Haemorrhage due to Ruptured Saccular Aneurysm

• Primary Intracerebral Haemorrhage• Arteriovenous Malformation (AVM)

Craniocerebral Trauma

• The basic problem is both simple & complex• simple 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 INJURY

• Skull Fractures• Concussion and Contusion • Diffuse Axonal Injury • Acute Epidural Haemorrhage• Acute and Chronic Subdural Hematomas• Penetrating Injuries

SECONDARY INJURY

• Hypoxia, hypotension• Elevated intracranial pressure• Hyperglycemia, Seizures • Deep Venous Thrombosis and Pulmonary

Embolism• Hyperthermia, infection

NEUROIMAGING

NEUROIMAGING

Intracranial Neoplasms

• Benign or malignant• (1) primary tumors • (2) secondary tumors

Primary brain tumors

• Pilocytic astrocytoma, grade I, Astrocytoma, grade II

• Anaplastic astrocytoma, grade III, Glioblastoma multiforme, grade IV

• Oligodendroglioma, Ependymoma• Choroid plexus papilloma, Neuronal tumors or

mixed tumors (e.g., ganglioglioma)• Embryonal tumors (medulloblastoma, PNET)• Pineal parenchymal tumors

Other intracranial tumors• Metastatic tumors (breast and lung most common)• Meningeal tumors (meningioma), Vascular tumors

(hemangioblastomas), Pituitary adenomas• Germ cell tumors (germinoma, teratoma)• Primary CNS lymphoma, Nerve sheath tumors

(vestibular schwannoma)• Developmental tumors (craniopharyngioma,

epidermoid, colloid cyst), Chondroid matrix tumors (chondrosarcoma, chordoma)

INFECTIONS

• Infections 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 limited

• resources 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.

INFECTIONS

• Infections 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.

INFECTIONS

• Meningitis : 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.

INFECTIONS

• These 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.

EPILEPSY

• epilepsy 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 SIGNS

• Sudden and usually brief, include motor, psychic, autonomic and sensory phenomenon, with or without alteration in consciousness or awareness

• the symptoms depend on the part of the brain involved in the epileptic neuronal discharge, and the intensity of the discharge

Headache (CEPHALGIA)