Gangguan Saraf Kranialis (Dr. Yuniarti SP.S)

GANGGUAN SARAF
KRANIALIS
Dr. Yuniarti, SpS
SMF Saraf RSUP Fatmawati

URUTAN PEMERIKSAAN
NEUROLOGI
1. Efaluasi fungsi serebral umum
2. Pemeriksaan fungsi saraf otak
3. Pemeriksaan fungsi motorik
4. Pemeriksaan fungsi sensorik
5. Pemeriksaan fungsi otonom
2/4/2018 add footer here (go to view menu and choose header) 2
Ad I.
 Derajat kesadaran pasien
 Perilaku umum
 Tingkahlaku intelektualistik
 Status emosional
 Isi dan cara berfikir
Pemeriksaan fungsi saraf otak
• N. I-II → kondisi diensefalon dan fosa kranii
anterior
• N. III-IV-VI → Kondisi mensefalon dan fosa kranii
media
• N. V → Kondisi PONS bagian tengah dan
petrosum
• N. VII-VIII → kondisi PONS kaudal dan MO
• N. IX-X-XI → kondisi MO bagian kaudal dan
daerah sekitar klivus Blumenbach
Pemeriksaan N I-XII
 N. I olfaktorius
- Persiapan : S dan K berlaku
- Pemeriksaan
- Arti klinis : Anosmia
Hiposmia
Hiperosmia
Parosmia/kakosmia
Halusinasi olfaktori
N II (N.Optikus)
Retina k genik lat->korteks visual
kolikulus superior
• Persiapan
• Pemeriksaan: - Visus.
- Warna
- Lapang penglihatan
- Funduskopi
• Arti Klinis:
Gangguan N optikus : - Papil edema.
- Papilitis
N III (Okulomotorius)
N IV (Trokhlearis).
N Abdusens)
• Arti klinis :
- Retraksi kelopak mata
- Ptosis
- Ggn Gerak bola mata
- Midriasis
N V. (Trigeminus)
• Pemeriksaan :
- Fs motorik
- Fs sensorik
- Reflek trigeminal
- Arti Klinis:
- Neuralgia trigeminal: - idiopatik
- simtomatik
N VII (Fasialis)
• Pemeriksaan
– Fs motorik
– Fs viserosensorik dan visero motorik
• Arti klinis
– Lesi UMN;
– Lesi LMN.
N. VIII (N Akustikus)
- n Kokhlearis
- n Vestibularis
• Pemeriksaan ;
• Arti Klinis
– Ggn Fs Pendengaran (n kokhlearis)
– Ggn Fs Keseimbangan (n vestibularis)
– Ggn Fs gabungan.
N IX – X (n. Glosopharingeus.
n Vagus)
• Pemeriksaan
- orofarings; - istirahat dan fonasi
- Refleks
- Laring
• Arti klinis;
- Disfagia
- Ggn pengecapan
- Paralisis faring/Laring
N. XI- XII n ASESORIUS
n Hipoglosus)
• Pemeriksaan
• Arti klinis;
- Lesi UMN
- Lesi LMN
CN I: Olfactory
Usually not tested.

Rash, deformity of nose.
Test each nostril with essence bottles
of coffee, vanilla, peppermint.
CN II: Optic
-With patient wearing glasses, test each eye

separately
on eye chart/ card using an eye cover.
-Examine visual fields by confrontation by wiggling
fingers 1 foot from pt's ears, asking which they see
move.
- Keep examiner's head level with patient's head.
If poor visual acuity, map fields using fingers and a

quadrant-covering card.
Look into fundi.

- Simple visual acuity examination
Visual acuity
If eye pain, injury, visual loss, check visual acuity before rest
of the exam or inserting medications into eyes [so don't get
sued].
Let pt to use glasses, contacts if available.
Put pt 20 feet from Snellen eye chart, or hold Rosenbaum
pocket card 14 inches away.
Pt. covers an eye at a time with a card, reading smaller letters
till stop.
Record smallest line read, eg 20/40.
Visual fields
Stand 2 feet in front of pt, who looks in Dr's eyes at eye-level.
Dr's hands to side half way between Dr and pt, wiggle fingers,
ask which they see move.
Repeat 2-3 to test both temporal fields.
If suspect abnormality, test 4 quadrants of each eye while
card covers other.
CN III, IV, VI: Oculomotor, Trochlear,
Abducens
Look at pupils: shape, relative size, ptosis.
Shine light in from the side to gauge pupil's light reaction.
• Assess both direct and consensual responses.
• Assess afferent pupillary defect by moving light in arc from
pupil to pupil. unne). Optionally: as do arc test, have pt place
a flat hand extending vertically from his face, between his
eyes, to act as a blinder so light can only go into one eye at a
time.
"Follow finger with eyes without moving head": test the 6
cardinal points in an H pattern.
• Look for failure of movement, nystagmus [pause
to check it during upward/ lateral gaze].
Convergence by moving finger towards bridge of
pt's nose.
Test accommodation by pt looking into distance,
then a hat pin 30cm from nose.
If MG suspected: pt. gazes upward at Dr's finger
to show worsening ptosis.
CN V: Trigeminal
Corneal reflex: patient looks up and away.

• Touch cotton wool to other side.
• Look for blink in both eyes, ask if can sense it.
• Repeat other side [tests V sensory, VII motor].
Facial sensation: sterile sharp item on forehead,
cheek, jaw.
• Repeat with dull object. Ask to report sharp or
dull.
• If abnormal, then temperature [heated/ water-
cooled tuning fork], light touch [cotton].
Motor: pt opens mouth, clenches teeth
(pterygoids).
• Palpate temporal, masseter muscles as they
clench.
Test jaw jerk:
Dr's finger on tip of jaw.
Grip patellar hammer halfway up shaft and tap
Dr's finger lightly.
Usually nothing happens, or just a slight closure.
If increased closure, think UMNL,
esp pseudobulbar palsy.
CN VII: Facial
Inspect facial droop or asymmetry.

Facial expression muscles: pt looks up and
wrinkles forehead.
• Examine wrinkling loss.

• Feel muscle strength by pushing down on each
side preserved because of bilateral innervation].
Pt shuts eyes tightly: compare each side.

Pt grins: compare nasolabial grooves.
Also: frown, show teeth, puff out cheeks.
Corneal reflex already done.
CN VIII: Vestibulocochlear (Hearing, Vestibular
rarely)
Dr's hands arms length by each ear of pt.

• Rub one hand's fingers with noise on one side,
other hand noiselessly.
• Ask pt. which ear they hear you rubbing.
• Repeat with louder intensity, watching for
abnormality.
Weber's test: Lateralization
• 512/ 1024 Hz [256 if deaf] vibrating fork on top of
patients head/ forehead.
• "Where do you hear sound coming from?"
• Normal reply is midline.
Rinne's test: Air vs. Bone Conduction
• 512/ 1024 Hz [256 if deaf] vibrating fork on

mastoid behind ear. Ask when stop hearing it.
• When stop hearing it, move to the patients ear so
can hear it.
• Normal: air conduction [ear] better than bone
conduction [mastoid].
If indicated, look at external auditory canals,

eardrums
CN IX, X: Glossopharyngeal, Vagus
Voice: hoarse or nasal.
Pt. swallows, coughs (bovine cough: recurrent
laryngeal).
Examine palate for uvular displacement. (unilateral
lesion: uvula drawn to normal side).
Pt says "Ah": symmetrical soft palate movement.
Gag reflex [sensory IX, motor X]:
• Stimulate back of throat each side.
• Normal to gag each time.
CN XI: Accessory
From behind, examine for trapezius atrophy,

asymmetry.
Pt. shrugs shoulders (trapezius).
Pt. turns head against resistance: watch, palpate
SCM on opposite side.
CN XII: Hypoglossal
Listen to articulation.
Inspect tongue in mouth for wasting, fasciculations.
Protrude tongue: unilateral deviates to affected
side.
TERIMA KASIH
Email : fritzsumantri@yahoo.com
Web : www.fritzsumantri.blogspot.com

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GANGGUAN SARAF

Dr. Yuniarti, SpS

SMF Saraf RSUP Fatmawati

Usually not tested.

-With patient wearing glasses, test each eye

If poor visual acuity, map fields using fingers and a

Look into fundi.

Corneal reflex: patient looks up and away.

Inspect facial droop or asymmetry.

• Examine wrinkling loss.

Pt shuts eyes tightly: compare each side.

Dr's hands arms length by each ear of pt.

• 512/ 1024 Hz [256 if deaf] vibrating fork on

If indicated, look at external auditory canals,

From behind, examine for trapezius atrophy,

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