ASPEK NEUROLOGI KELUMPUHAN MOTORIK · PDF file"infeksi morbus hansen. gangguan neuromuscular...
Transcript of ASPEK NEUROLOGI KELUMPUHAN MOTORIK · PDF file"infeksi morbus hansen. gangguan neuromuscular...
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FK UWK SURABAYA
ASPEK NEUROLOGIKELUMPUHAN MOTORIK
Utoyo Sunaryo
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DEFINISI• SYNONIM :
PARALYSIS = PALSY.• PARESIS : INCOMPLETE PARALYSIS• PARALYSIS / PLEGIA :
TOTAL PARALYSIS.• ISTILAH KEDOKTERAN :
SETIAP KELEMAHAN OTOT DALAMBERBAGAI DERAJAT TERTENTUDISEBABKAN OLEH GANGGUANSARAF PENGGERAKNYA
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ANATOMI SISTIM MOTORIK
• TRAKTUS KORTIKOSPINALIS( TRAKTUS PIRAMIDALIS)
KORTEKS MOTORIK CORONA RADIATA KAPSULA INTERNA MESENSEFALON PONS MEDULAOBLONGATA BAG BAWAH MENYILANG(85 %) KONTRALATERAL DI DEKUSASIOPIRAMIDALIS( SETINGGI FOR. MAGNUM )
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ANATOMI SISTIM MOTORIK(cont’)
• TRAKTUS PIRAMIDALIS KORNUANTERIOR Med Spinalis RADIKSANTERIOR PLEXUS SARAFPERIFER
NEURO MUSCULAR JUNCTION OTOT
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JENIS KELUMPUHAN
o KELUMPUHAN LOWERMOTOR NEURON ( L.M.N).
o KELUMPUHAN UPPERMOTOR NEURON ( U.M.N)
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SINDROMA U.M.N
• TONUS SPASTIK/KAKU.• REFLEKS PATOLOGIS (+)• REFLEKS FISIOLOGIS MENINGKAT• ATROFI OTOT JARANG , KECUALI
BILA SUDAH LAMA.
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SINDROMA L.M.N
• TONUS FLAKSID/LAYU.• REFLEKS PATOLOGIS ( -).• REFLEKS FISIOLOGIS MENURUN.• ATROFI OTOT SERING DIJUMPAI.
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“THE MEDICAL RESEARCHCOUNCIL”
• 5= KEKUATAN OTOT NORMAL.• 4= GERAKAN OTOT MODERAT TERHADAP
TAHANAN.• 3= OTOT MASIH DPT MELAWAN GRAVITASI ,
TAPI TDK DPT MELAWAN TAHANAN.• 2= OTOT TDK DPT MELAWAN GRAVITASI.• 1= “FLICKER” ATAU TAMPAK KONTRAKSI
OTOT.
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• HEMIPARESIS/PLEGI.• TETRAPARESIS/PLEGI.• PARAPARESIS/PLEGI.• MONOPARESIS/PLEGI.• DIPLEGI• PARALISIS FASIALIS.
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• HEMIPARESIS/PLEGI.• TETRAPARESIS/PLEGI.• PARAPARESIS/PLEGI.• MONOPARESIS/PLEGI.• DIPLEGI• PARALISIS FASIALIS.
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HEMIPARESIS/PLEGI
HEMIPLEGI : PARALISIS TOTAL DARIEKSTREMITAS DARI SATU SISITUBUH.
HEMIPARESIS: PARALISIS PARSIALDARI EKSTREMITAS DARI SATU SISITUBUH.
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LESI DIATAS DEKUSASIOPIRAMIDALIS KELUMPUHAN /HEMI/MONOPLEGI / PARESISKONTRA LATERAL.
LESI DIBAWAH DEKUSASIOPIRAMIDALIS KELUMPUHAN /HEMI/MONOPLEGI / PARESISIPSILATERAL.
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ETIOLOGI
• STROKE.• CEDERA KEPALA/TRAUMA KEPALA.• “BRAIN DISORDER” MENINGITIS. ENSEFALITIS. TUMOR SEREBRAL. SEREBRAL PALSI. ABSES OTAK. AVM DSB.
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Dr.J.Husada11-2003
ApoptoticCell DeathNecroticCell Death
IschemicInjury
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• HEMIPARESIS/PLEGI.• TETRAPARESIS/PLEGI.• PARAPARESIS/PLEGI.• MONOPARESIS/PLEGI.• DIPLEGI• PARALISIS FASIALIS.
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TETRAPARESIS/PLEGI
• ADALAH KEADAAN YANGMENGGAMBARKAN KELUMPUHANTOTAL ATAU PARSIAL SELURUHKEEMPAT EKSTREMITAS.
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ETIOLOGI
LESI TRANSVERSAL SERVIKALBAWAH.MISAL: CEDERA LEHER.
POLINEURITIS.SINDROMA GUILLAIN BARRE ( GBS).MIASTENIA GRAVIS.PERIODIK PARALISIS.
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CHRISTOPHER REEVE
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MIASTHENIA GRAVIS
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• HEMIPARESIS/PLEGI.• TETRAPARESIS/PLEGI.• PARAPARESIS/PLEGI.• MONOPARESIS/PLEGI.• DIPLEGI.• PARALISIS FASIALIS.
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PARAPARESIS/PLEGI
• ADALAH KEADAAN YANGMENGGAMBARKAN KELUMPUHANTOTAL/PARSIAL EKSTREMITASBAWAH.
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Pott’s disease with sinustracts
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MRI Scan
Pott’s Disease withL4 vertebralcollapse
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X-ray – Pott’s disease
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• HEMIPARESIS/PLEGI.• TETRAPARESIS/PLEGI.• PARAPARESIS/PLEGI.• MONOPARESIS/PLEGI.• DIPLEGI.• PARALISIS FASIALIS.
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MONOPARESIS/PLEGI
• ADALAH KEADAAN YANGMENGGAMBARKAN KELUMPUHANTOTAL/PARSIAL SATU EKSTREMITASSAJA.
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ORANG TERKENAL YANGPERNAH KENA POLIO
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Top right
Normal view.
Middle rightHerniated disk
Bottom right.
Spinalstenosis.
Left: lateral view ofthe lumbar spine,showing anteriordisplacement of L5on sacrum(spondylolisthesis).
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• HEMIPARESIS/PLEGI.• TETRAPARESIS/PLEGI.• PARAPARESIS/PLEGI.• MONOPARESIS/PLEGI.• DIPLEGI.• PARALISIS FASIALIS.
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• HEMIPARESIS/PLEGI.• TETRAPARESIS/PLEGI.• PARAPARESIS/PLEGI.• MONOPARESIS/PLEGI.• DIPLEGI.• PARALISIS FASIALIS.
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PARALISIS FASIALISDEXTRA SENTRAL
PARALISIS FASIALISDEXTRA PERIFER
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Neuromuscular Weakness
U.M.N Myoneural Junction MuscleNerve roots &Peripheral NervesL.M.N
BRAIN
InfarctionHemorhageNeoplasmInfection
BRAINSTEM
InfarctionMotor Neuron DiseaseNeoplasm
SPINAL CORD
Demyeliting dieseaseNeoplasmPrimary lateral sclerosis
BRAINSTEM
Pseudobulbar palsySyringobulbiPoliomielitis
SPINAL CORD
ProgresiveMuscle atrophySryringomyeliaPoliomielitis
NERVE ROOTS
Intervertebral diskHerniation.Metabolic radiculopati
PERIPHERALNERVES
Metabolic disorderInfLamatory disorderTrauma
Myasthenia gravisBotulism Polimyositis
Muscular distrophyPeriodic Paralysis
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PENYAKIT KORNUANTERIOR
• PROGRESSIVE INFANTILE SPINALATROPHY.
• JUVENILE SPINAL ATROPHY• AMYOTROPHIC LATERAL
SCLERORIS (ALS)• POLIOMYELITIS.
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GANGGUAN PADA RADIKS
• MONORADIKULONEUROPATI.( TRAUMA, INFEKSI, HERPES,KOMPRESI OK TU,HNP,METASTASIS, SPONDILITIS TB)
• POLIRADIKULONEUROPATI( G.B.S )
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GANGGUAN SARAF TEPI
1. MONONEUROPATI.( KOMPRESI, INFEKSI MH, HERPES,TRAUMA )
• GG N. RADIALIS.• GG N. MEDIANUS ( CTS)• GGN. N TIBIALIS POSTERIOR ( TTS)• GG N. ULNARIS• GG N. AKSILARIS.• GG N. PERONEUS• GG N. ISHIADIKUS.
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GANGGUAN SARAF TEPI( CON’T)
2. POLINEUROPATI.• DIABETES MELLITUS.• DEFISIENSI VIT B1• UREMIA.• INFEKSI MORBUS HANSEN
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GANGGUANNEUROMUSCULAR
JUNCTION• MIASTHENIA GRAVIS.• BOTULISM
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GANGGUAN PADA OTOT
1. HEREDITER.• DYSTROPHIA MUSCULARUM
PROGRESSIVA ( DUCHENNE)• MIOTONIA CONGENITAL• DISTROPHIA MIOTONIKA.• FASCIO SCAPULO HUMERAL• PROGRESIVE CHRONIC
OPHTALMOPLEGIA
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GANGGUAN PADA OTOT( CON’T)
2. ACQUIRED• POLIMYOSITIS.• POLIMIALGIA REMATIKA.• POLIMIOPATI.• PERIODIK PARALISIS
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Terima Kasih