1011 saraf (07) Pemeriksaan Neuro
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Transcript of 1011 saraf (07) Pemeriksaan Neuro
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dr. H. Agus Taufiqurrohman, M.Kes, Sp.SDepartment of Neurology
School of Medicine
UII, 2009
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ANAMNESISANAMNESIS
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SPESIFIKSPESIFIK
NYERINYERITUMORTUMORVASKULERVASKULEREPILEPSIEPILEPSIMGMGGBSGBSLBPLBPETCETC
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NYERI (KEPALA)NYERI (KEPALA)
ONSETONSET DURASIDURASI SIFATSIFAT INTENSITASINTENSITAS FREKWENSIFREKWENSI
GEJAL PENYERTAGEJAL PENYERTA YG MEMBERATKANYG MEMBERATKAN YG MERINGANKANYG MERINGANKAN TERAPITERAPI
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EPILEPSIEPILEPSI
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TUMORTUMOR
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VASKULERVASKULER
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LBPLBP
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KASUS LAINKASUS LAIN
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PEMERIKSAANPEMERIKSAAN
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Stroke / vaskulerStroke / vaskulerLBPLBPTRAUMATRAUMAPARESEPARESEVERTIGOVERTIGO
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TINGKAT KESADARANTINGKAT KESADARAN
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Compos MentisCompos Mentis (conscious),(conscious),....ApatisApatis..DeliriumDelirium, ., .SomnolenSomnolen (Obtundasi, Letargi),(Obtundasi, Letargi),..Stupor Stupor ((soporo komasoporo koma)),, Coma Coma ((comatosecomatose)),,
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kwalitatifkwalitatif
Compos MentisCompos MentisApatisApatisDeliriumDeliriumLethargyLethargySomnolenSomnolenStupor Stupor ComaComa
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Alertness
Lethargy
Stupor
Obtundation
COMA
DEATH
delirium
F. FillouxOctober 2002
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a. Membuka mata (1-4)
b. Respon verbal (bahasa lisan) (1-5)
c. Reaksi gerakan motorik(1-6)
GCS = E+V+M
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1). Reaksi membuka mata
4 Buka mata spontan
3 Buka mata bila dipanggil/rangsangan suara
2 Buka mata bila dirangsang nyeri
1 Tak ada reaksi dengan rangsangan apapun
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2.) Reaksi berbicara
5 Komunikasi verbal baik, jawaban tepat
4 Bingung, disorientasi waktu, tempat, dan orang
3 Dengan rangsangan, reaksi hanya kata, tak berbentuk kalimat
2 Dengan rangsangan, reaksi hanya suara, tak terbentuk kata
1 Tak ada reaksi dengan rangsangan apapun
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Reaksi gerakan lengan/tungkai
6 Mengikuti perintah
5 Dengan rangsangan nyeri, dapat mengetahui tempat rangsangan
4 Dengan rangsangan nyeri, menarik anggota badan
3 Dengan rangsangan nyeri, timbul reaksi fleksi abnormal
2 Dengan rangsangan nyeri, timbul reaksi ekstensi abnormal
1 Dengan rangsangan nyeri, tidak ada reaksi.
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General Appearance General Appearance
Level of consciousnessLevel of consciousnessPersonal Hygiene and DressPersonal Hygiene and DressPosture and Motor Activity.Posture and Motor Activity.Height, Build and WeightHeight, Build and Weight . .
04/12/2304/12/23 Neurol_Examination1Neurol_Examination1 2626
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Vital SignsVital Signs. .
These includeThese include:: temperature,temperature, pulse, pulse, respiratory rate and respiratory rate and blood pressure blood pressure
04/12/2304/12/23 Neurol_Examination1Neurol_Examination1 2828
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REFLEKS :JAWABAN SPONTAN TERHADAP SUATU RANGSANGAN
TEKNIK PENGETUKAN:• Gerakan tangan bukan lengan• Tepat pada tendon, direct-indirect• Simetris• Intensitas• Santai tidak tegang
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Refleks Superfisial adalah gerakan reflektorik yang timbul sebagai respon atas stimulasi terhadap kulit atau mukosa. Berbeda dengan refleks dalam, refleks superfisial tidak saja mempunyai busur refleks yang segmental melainkan mempunyai komponen supraspinal juga.
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REFLEKS PATOLOGIS :
Refleks-refleks yang tidak dapat dibangkitkan pada orang sehat kecuali
bayi
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Variabel UMN/SPASTIC LMN/FLACCID
Kekuatan 0 0
Gerakan Terbatas 0 Terbatas 0
Trofi Normal Hipo atrofi
Tonus Normal Hiper Hipo
Klonus (+) (-) (-)
Refleks Fisiologis (+) hiper Hipo (-)
Refleks Patologis (+) (-)
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KEKUATAN ARTI KLINIS
0 Tidak ada kontraksi, tidak ada gerakan
1 Ada kontraksi, tidak ada gerakan
2 Ada kontraksi, ada gerakan tanpa melawan gravitasi (geser)
3 Ada gerakan melawan gravitasi tanpa beban/tahanan
4 Ada gerakan melawan gravitasi dengan beban atau tahanan terbatas
5 Normal
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ATROFI: Hilangnya atau mengecilnya bentuk otot disebabkan musnahnya serabut otot
ATROFI: • Neurogenic : lemah mengecil• Miogenic : mengecil lemah• Inaktifitas : (disuse atrofi)
hilangnya Sarcoplasma
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TONUS :Tahanan otot sehat, normal pada waktu sehat
Syarat :Pasien tenang, periksa dengan tenang, tangan tidak dingin1. Tes kepala jatuh2. Tes lenggang lengan3. Tes goyang tangan4. Tes lengan jatuh5. Tes goyang tungkai6. Tes tungkai jatuh
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SENSIBILITASSENSIBILITAS
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HiperestesiaHiperestesia
Meningkatnya sensitivitas terhadap Meningkatnya sensitivitas terhadap
stimulasi, tidak termasuk di dalamnya stimulasi, tidak termasuk di dalamnya
sensasi khusus (indera lain)sensasi khusus (indera lain)
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AnalgesiaAnalgesia
Tidak adanya respon nyeri terhadap Tidak adanya respon nyeri terhadap
stimulasi yang dalam keadaan normal stimulasi yang dalam keadaan normal
menimbulkan nyerimenimbulkan nyeri
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HipoestesiaHipoestesia
Menurunnya sensitivitas terhadap Menurunnya sensitivitas terhadap
stimulasi, kecuali sensasi khusus (indera stimulasi, kecuali sensasi khusus (indera
lain)lain)
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PENILAIAN NYERIPENILAIAN NYERI
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Burning, feeling like the feet are on fire
Stabbing, like sharp knives Lancinating, like electric shocks
Freezing, like the feet are on ice, although they feel warm to touch
Modified by Meliala 2006
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Visual Analogue ScaleVisual Analogue Scale
0 5 10
Tidak Nyeri Paling Nyeri yg terbayangkan
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PENUNJANGPENUNJANG NF :NF :
EEG-BMEEG-BMENMGENMGBERABERA
LABORATORIUMLABORATORIUM RADIOLOGI RADIOLOGI
RXRXCT SCANCT SCANMRIMRI
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NormalMCV SCV
Demyelination
Axonal degeneration
Prolonged latency, duration, and low amplitude
Low amplitude, but no delay of latency
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Visual Analogue ScaleVisual Analogue Scale
0 5 10
Tidak Nyeri Paling Nyeri yg terbayangkan