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NEUROLOGY FOR INSTRUCTOR
NEUROLOGY FOR
INSTRUCTOR

ACHDIAT AGOES

FKIK UIN, Senin 30 OKTOBER, 2017

PERAN INSTRUKTUR/TUTOR DALAM PEMBELAJARAN NEUROLOGI
PERAN INSTRUKTUR/TUTOR
DALAM PEMBELAJARAN
NEUROLOGI

SANGAT BESAR & PENTING BAHKAN DAPAT DIKATAKAN INSTRUKTUR/TUTOR ADALAH

SEGALA-GALANYA

PENDAHULUAN
PENDAHULUAN
PENDAHULUAN  PERAN TUTOR ADALAH MENGANTARKAN MAHASISWA AGAR MEMAHAMI DAN MAMPU MENJIWAI:  Organisasi susunan saraf

PERAN TUTOR ADALAH MENGANTARKAN MAHASISWA AGAR

MEMAHAMI DAN MAMPU MENJIWAI:

Organisasi susunan saraf pusat

Gaya berfikir neurologis Proses patologi pada neurologi

Pemeriksaan neurologi

GAYA BERFIKIR NEUROLOGI
GAYA BERFIKIR NEUROLOGI

SELALU TEPAT

SELALU AKURAT SELALU CEPAT

SELALU BERHASIL

BERHASIL  APA SELALU?
BERHASIL
 APA SELALU?
BERHASIL  APA SELALU?  TIDAK!  TETAPI SELALU ADA INTERMEDIATE OBJECTIVE atau SASARAN ANTAR 

TIDAK!

TETAPI SELALU ADA INTERMEDIATE

OBJECTIVE atau SASARAN ANTAR

AT LEAST POSITIVE THINKING

SELALU MENYIAPKAN SECOND SCENARIO

Organisasi SSP & SST
Organisasi SSP & SST

SUSUNAN SARAF adalah sangat komplex.

Susunan

saraf

mempunyai

beberapa

tingkatan (?) level

Sehingga distribusi dan tipe masalah klinis sangat tergantung tingkat/level yang

terkena.

INI MENARIK SEKALI
INI MENARIK SEKALI
INI MENARIK SEKALI  KARENA mampu menjelaskan mengapa pada seseorang yang terkena stroke dapat mengalami kelumpuhan

KARENA mampu menjelaskan mengapa

pada seseorang yang terkena stroke dapat

mengalami kelumpuhan motorik

sedangkan pada orang yang lain yang terganggu adalah kemampuan mengingat

kembali peristiwa yang sudah di alami?

Organisasi SS (Susunan Saraf)
Organisasi SS (Susunan Saraf)

SSP SST SSO otonom (pembagian seperti ini tidak ada pada sistema organa lainnya)

ISTILAH 
ISTILAH
ISTILAH  Ensefalopati: abnormality of the brain (may be refined by terms such as focal, diffuse,

Ensefalopati: abnormality of the brain (may

be refined by terms such as focal, diffuse,

metabolic or toxic).

Mielopati: abnormality of the spinal cord.

Radikulopati: abnormality of a single nerve

root.

Poliradikulopati:

nerve roots.

abnormality

of

many

Plexopati: abnormality of a plexus (brachial

or lumbar).

Terminology 
Terminology
Terminology  many nerves. Polineuropati @ neuropati: abnormality of  Mononeuropati: abnormality of single named

many nerves.

Polineuropati @ neuropati: abnormality of

Mononeuropati: abnormality of single named

nerve.

Mononeuritis multiplex: an abnormality of

multiple named nerves.

Myopati: abnormality of muscle (myositis or

polymyositis - inflammation of muscle).

Meningitis: inflammation of the meninges.

Levels of the nervous system P U S A T T E P I
Levels of the nervous system P U S A T T E P I

Levels of the nervous system

Levels of the nervous system P U S A T T E P I

P

U

S

A

T

T

E

P

I

The central nervous system 
The central nervous system
The central nervous system  The cerebral hemispheres  The basal ganglia  Cerebellum  Brain

The cerebral hemispheres

The basal ganglia

Cerebellum

Brain stem

The spinal cord

KELAINAN DI SINI KITA NAMAKAN LESI SENTRAL

-sensation of

the opposite

side of the body

-appreciation of

space, esp. in

the non-

dominant

hemisphere

The cerebral hemispheres

the non- dominant hemisphere The cerebral hemispheres - insight and control of emotions - dominant hemisphere
- insight and control of emotions - dominant hemisphere : output of speech -motor control
- insight and
control of
emotions
- dominant
hemisphere :
output of
speech
-motor control
of the opposite
side of the body
appreciation
of vision.
- memory and emotions - dominant hemisphere : comprehension of speech
- memory and emotions
- dominant hemisphere
: comprehension of
speech
side of the body appreciation of vision. - memory and emotions - dominant hemisphere : comprehension
SEKARANG MARI KITA LIHAT SECARA RINCI
SEKARANG MARI KITA LIHAT SECARA RINCI
SEKARANG MARI KITA LIHAT SECARA RINCI
SEKARANG MARI KITA LIHAT
SECARA RINCI
Brain stem 
Brain stem
Brain stem  The reticular formation, which maintains consciousness  The cranial nerves  The descending

The reticular formation, which

maintains consciousness

The cranial nerves

The descending motor tract

The ascending sensory tract

Brain stem
Brain stem
The peripheral nervous system
The peripheral nervous
system

nerve roots

brachial plexus and lumbosacral plexus Peripheral nerve

Pleksus Brakhialis N . N. radialis Medialis Radiks Pleksus Pleksus Lumbosacralis N. Ulnaris Srf
Pleksus Brakhialis N . N. radialis Medialis Radiks Pleksus Pleksus Lumbosacralis N. Ulnaris Srf
Pleksus Brakhialis N . N. radialis Medialis Radiks Pleksus Pleksus Lumbosacralis N. Ulnaris Srf
Pleksus Brakhialis N . N. radialis Medialis Radiks Pleksus Pleksus Lumbosacralis N. Ulnaris Srf

Pleksus

Brakhialis

Pleksus Brakhialis N . N. radialis Medialis
Pleksus Brakhialis N . N. radialis Medialis

N.

N.

radialis

Medialis

Radiks

Pleksus

Pleksus

Lumbosacralis

N. Ulnaris

Srf Perifer

-

Motorik

-

Sensoris

- Otonom

N. Femoralis

N. Ischiadikus

N.

Cut. Post or

N.

Pudendus

SS Otonomik  Sistem Simpatik , dari T1 hingga L2  Sistem Parasimpatik dari batang
SS Otonomik  Sistem Simpatik , dari T1 hingga L2  Sistem Parasimpatik dari batang
SS Otonomik
SS Otonomik
SS Otonomik  Sistem Simpatik , dari T1 hingga L2  Sistem Parasimpatik dari batang otak

Sistem Simpatik, dari T1 hingga L2 Sistem Parasimpatik dari batang otak

(berhubungan dengan saraf kranial 3, 7

dan 9) dan segmen the spinal segments

S2-4

Cara Berfikir Neurologis - Diagnosis neurologis - Diagnosis topis (Different levels diagnosis) of - Diagnosis
Cara Berfikir Neurologis - Diagnosis neurologis - Diagnosis topis (Different levels diagnosis) of - Diagnosis
Cara Berfikir Neurologis - Diagnosis neurologis - Diagnosis topis (Different levels diagnosis) of - Diagnosis
Cara Berfikir Neurologis
Cara Berfikir Neurologis

- Diagnosis neurologis

- Diagnosis

topis

(Different

levels

diagnosis)

of

- Diagnosis Klinis Pertimbangkan

Penyakit yang Sering Terjadi dan

Penting (Common and important

disorders)

- Diagnosis Etiologis

- Pemeriksaan Teliti

Proces Diagnosis meliputi :  Gejala dan tanda neurologis  Gambaran Klinis  Neuroanatomi 
Proces Diagnosis meliputi :  Gejala dan tanda neurologis  Gambaran Klinis  Neuroanatomi 
Proces Diagnosis meliputi :
Proces Diagnosis meliputi :
Proces Diagnosis meliputi :  Gejala dan tanda neurologis  Gambaran Klinis  Neuroanatomi  Taking

Gejala dan tanda neurologis Gambaran Klinis

Neuroanatomi

Taking a neurological history and

conducting a neurological examination

A method of synthesizing this information

Making a neurological diagnosis 1. Wiring diagram analysis' or anatomical localization.
Making a neurological diagnosis
1. Wiring diagram analysis' or
anatomical localization.

deduction of the site of a lesion

primarily a synthesis of findings on

clinical examination

e.g. the recognition that a combined trigeminal, facial and auditory nerve

lesion is sited at the cerebellopontine

angle.

Making a neurological diagnosis 2. Pattern recognition / syndromic
Making a neurological diagnosis
2. Pattern recognition / syndromic
a neurological diagnosis 2. Pattern recognition / syndromic diagnosis The only method in many neurological diagnoses

diagnosis

The only method in many neurological

diagnoses where the site of the lesion

cannot be deduced neuroanatomically, e.g. migraine, Parkinson's disease

Neurological thinking
Neurological thinking
Different levels of diagnosis
Different levels of diagnosis
Different levels of diagnosis
Different levels of diagnosis
Different levels of diagnosis
Different levels of diagnosis
Different
levels of
diagnosis
Motoric Level
Motoric Level
Motoric Level
Motoric Level
Sensory Level
Sensory Level
Investigation
Investigation
Investigation  To confirm the dx , e.g. finding a positive anti-acetylcholine receptor antibody confirms the

To confirm the dx, e.g. finding a

positive anti-acetylcholine receptor

antibody

confirms the diagnosis of

myasthenia gravis.

To support the dx, e.g. finding periventricular white matter changes

on MRI supports the clinical dx of

multiple sclerosis.

Investigation
Investigation
Investigation  To exclude alternative dx , e.g. an erythrocyte sedimentation rate test in a patient

To exclude alternative dx, e.g. an

erythrocyte sedimentation rate test in a

patient with late-onset headaches to

exclude the diagnosis of temporal

arteritis.

To look for the cause of the neurological problem, e.g. seeking risk

factors for atherosclerosis and evidence

of carotid stenosis in a patient following

a small anterior circulation stroke

Pathological processes in neurology SIVE
Pathological processes in neurology
SIVE
Pathological processes in neurology SIVE  S ystemic - abnormalities in the nervous system secondary to

Systemic - abnormalities in the nervous system secondary to systemic disease

Intrinsic - arising within the nervous system Vascular - resulting from disturbances in the blood supply to the nervous system Extrinsic - affecting the nervous system from outside.

SIVE
SIVE
SIVE

SIVE

Systemic
Systemic
Vascular 
Vascular
Vascular  Haemorrhage - can be within the substance of the brain, in the subarachnoid space,

Haemorrhage - can be within the

substance of the brain, in the

subarachnoid space, in the subdural

compartment or the extradural space.

Infarction - can be caused by an

embolus, thrombosis or arterial disease

such as vasculitis. With the exception of subdural haematoma, these are

characterized by a sudden onset.

Extrinsic
Extrinsic
Intrinsic MIND PIG
Intrinsic
MIND PIG

Metabolic

Infectious

Neoplastic

Degenerative

Paroxysmal

Immunological

Genetic.

Degenerative
Degenerative
Neurological Investigation  Neuroradiology
Neurological Investigation
 Neuroradiology

EEG

Nerve conduction studies (NCS)

Neurogenetics

CSF and LP

Neuroradiology
Neuroradiology
Neuroradiology

Neuroradiology

Neuroradiology
EEG
EEG
EEG
EEG
EEG
EEG
NCS Nerve Conduction Study
NCS Nerve Conduction Study
NCS Nerve Conduction Study
NCS
NCS

Nerve Conduction Study

NCS Nerve Conduction Study
CSF
CSF
LP - Lumbar Puncture
LP - Lumbar Puncture
Conclusion 
Conclusion
Conclusion  The cerebral hemispheres control the opposite side of the body.  Language is found

The cerebral hemispheres control the

opposite side of the body. Language is found in the dominant hemisphere.

The spinal cord is organized segmentally

Diagnoses can be made at different levels, for example syndromic, radiological or

pathological.

Common disorders are important because

they are common.

Conclusion 
Conclusion
Conclusion  Pathological processes affecting the nervous system can be classified as systemic, vascular, extrinsic or

Pathological processes affecting the

nervous system can be classified as

systemic, vascular, extrinsic or intrinsic.

Extrinsic disorders usually require neurosurgical management.

Intrinsic processes can be divided into

infectious, metabolic, immunological,

neoplastic, degenerative and

paroxysmal.

STUDI KASUS

Seorang laki-laki umur 68 th, gemuk (terutama perutnya), bangun pagi jam 05.00 ke kamar mandi, tiba-tiba lemah ½ kanan, sulit

bicara. Dibawa ke UGD: Kesadaran: Sadar , Tensi 170/90 parese N

VII/ XII kanan UMN, Riwayat DM (+), GD sewaktu: 184 g

1.

Pemeriksaan motorik Eks kanan, lengan tangan tidak bisa

diangkat melawan gravitasi tetapi masih bisa menggerakan

jari-jari tangan, sedangkan tungkai kanan bisa diangkat

melawan gravitasi tetapi dengan tahanan ringan sudah jatuh, maka status motoriknya adalah ssb:

2.

Normal

5

5

Penderita ini

… ….
….
5 5
5 5

Reflek patologis Babinski (+) pada kaki kanan

a. Terlihat Ibu jari kaki kearah …………, jari-jari kaki yang lain

ke arah ………

b. Cara pemeriksaannya dengan mengores …….

3. Hemiparese kanan dengan reflek patologis (+)

a. Artinya lesi di …………

b. Bila kelumpuhan lengan/tangan lebih berat daripada

tungkai/kaki maka letak lesi di ……….(cortex, sub kortex,

batang otak)

4. Pemeriksaan tonus

a. Dilakukan dengan cara ekstrimitas di ……….

b. Tanda spastifitas bila ditemukan fenomena ……………

c. Hal diatas menunjukkan lesi di ………………. (UMN, LMN,

Piramidal, Ekstrapiramidal)

Seorang laki-laki umur 68 th, gemuk (terutama perutnya), bangun pagi jam 05.00 ke kamar mandi, tiba-tiba lemah ½ kanan, sulit bicara. Dibawa ke UGD: Kesadaran: Com (GCS 4 x 6), afasia motorik, Tensi 170/90 parese N VII/ XII kanan UMN

Motorik: 2

5 3 5
5
3 5

Riwayat DM (+)

Reflek fisiologi: 3

2 3 2
2
3
2

GD sewaktu: 184 g

Reflek patologi: +

– + –
+

8. Lemah ½ kanan + Afasia, parese N VII XII kanan menunjukkan lesi oleh karena:

A. Cortex

B. Sub Cortex (Cap interna)

D. Pons

E. Medula Oblongata

9.

Sindroma klinis diatas dengan letak lesi di soal 1) cenderung:

A.

Tumor otak

D. Stroke Trombosis

B.

Trauma kapitis dengan perdarahan epidural

E. Stroke Emboli

C.

Stroke Perdarahan otak (ICH)

10. Arteri yang terganggu adalah:

A.

Arteri Cerebri Anterior

D. Arteri Cerebelum post interior

B.

Arteri Cerebri Media

E. Arteri Pontis

C.

Arteri Cerebri Posterior

11. Kalau penderita lemah ½ kanan, parese N VII, XII kanan tidak

ada afasia, maka letak lesi di:

A.

Cortex

D. Pons

B.

Sub Cortex (Capsula interna) E. Medula Oblongata

C.

Mesensefalon