PENGANTAR NEUROLOGI

Dr FUAD HANIF SpS M.KES

SMF NEUROLOGI RSUD
BANJAR
 BATASAN

• NEUROLOGI ADALAH ILMU YANG

MEMPELAJARI TENTANG
PERSARAFAN, BAIK
YANGFISIOLOGIS MAUPUN
PATOLOGIS.
SKEMA PEMERIKSAAN
PENYAKIT SARAF
1. SKEMA
ANAMNESA PEMERIKSAAN PEMERIKSAAN
FISIK PENUNJANG

GEJALA DIAGNOSA KLINIS

TUMPANG DIAGNOSA LOKALISASI
TINDIH DIAGNOSA ETIOLOGI

DIAGNOSA BANDING
CARA PEMERIKSAAN

• SSP (SUSUNAN SARAF PUSAT)

TERLETAK DIDALAM TULANG SEHINGGA
TIDAK DAPAT DI INSPEKSI, PALPASI, DAN
AUKULTASI SECARA LANGSUNG,
MELAINKAN DENGAN PEMERIKSAAN
KHUSUS (TEKNIK STIMULUS RESPONS)
URUTAN PEMERIKSAAN

1. ANAMNESA
• ALLO-ANAMNESA
• HETERO-ANAMNESA

2. PEMERIKSAAN FISIK
• STATUS PRAESENSI : vital sign
• STATUS INTERNA
ETIOLOGY IN NEUROLOGIC DISORDERS :

TRAUMA : HEAD / SPINE TRAUMA

VASCULAR : STROKE
INFECTION : ENCEPHALITIS, MENINGITIS
TUMOUR
DEGENRATIVE PROCESS : PARKINSON,
DEMENTIA
IDIOPATHIC : EPILEPSY
• STATUS NEUROLOGI
 RANGSANG MENINGEAL
 SARAF OTAK
 PEMERIKSAAN MOTORIK
 PEMERIKSAAN SENSORIK
 PEMERIKSAAN REFLEKS
 PEMERIKSAAN KOORDINASI
 PEMERIKSAAN FUNGSI LUHUR
ANAMNESA
1. KELUHAN UTAMA
2. RIWAYAT PENYAKIT SEKARANG
3. RIWAYAT PENYAKIT DAHULU
PEMERIKSAAN FISIK
1. KESADARAN
2. TEKANAN DARAH
3. NADI
4. RESPIRASI
5. TEMPERATUR
PEMERIKSAAN NEUROLOGIS
1. DIPERIKSA RANGSANGAN MENINGEAL
PEMERIKSAAN MELIPUTI :
• TANDA KAKU KUDUK
• TANDA KERNIG
• TANDA LASEQUE
• TANDA BRUDZINSKI
2. PEMERIKSAAN SARAF OTAK
SARAF YANG DIPERIKSA
• NERVUS I (OLFAKTORIUS)
• NERVUS II (OPTIKUS)
• NERVUS III, IV, VI
• NERVUS V (TRIGEMINUS)
• NERVUS VII (FASIALIS)
• NERVUS VIII (VESTIBULOCOCHLEARIS)
• NERVUS IX (GLOSSOFARINGEUS)
• NERVUS X (VAGUS)
• NERVUS XI (ASESORIUS)
• NERVUS XII (HIPOGLOSUS)
Cranial
Nerves
Nuclei of
Cranial
Nerves
Motoric
Cranial
Nerves
Nuclei
Sensoric
Cranial
Nerves
Nuclei
§ CN V (TRIGEMINAL)
SENSATION OF FACE, OPEN/CLOSE JAW,
MASTICATION, CORNEAL REFLEX)
CN VII (FACIAL)
FACIAL MOVEMENT AND
EXPRESSION,
TASTE OF ANTERIOR
TWO THIRD OF
TONGUE,
BLINKING REFLEX
Central 7th palsy Peripheral 7th palsy
CN VIII (VESTIBULO-COCHLEAR)
BALANCING
SENSE OF HEARING
CN IX (GLOSSOPHARYNGEAL) AND CN X
(VAGUS)

ELEVATION OF PALATE/UVULA, GAG REFLEX

CN XI (SPINAL
ACCESSORY) –
HEAD MOVEMENT,
SHOULDER
SHRUG/ELEVATION

CN XII – TONGUE
MOVEMENT
MOTOR SYSTEM

• MUSCLE BULK
• MUSCLE TONUS
• MUSCLE POWER/STRENGTH
• FASCICULATION
SENSORY SYSTEM

SUPERFICIAL SENSORY MODALITIES : PAIN

PERCEPTION, TEMPERATURE DISCRIMINATION, LIGHT
TOUCH

DEEP SENSORY MODALITIES : VIBRATION SENSE,

POSITION SENSE

CORTICAL FUNCTION : TWO-POINT DISCRIMINATION

(EXTINCTION), STEREOGNOSIS
REFLEXES

PHYSIOLOGIC REFLEX [MUSCLE STRETCH (DEEP)

REFLEX] : BICEPS, TRICEPS, BRACHIORADIAL, KNEE
JERK (KPR), ANKLE JERK (APR)

SUPERFICIAL REFLEX : ABDOMINAL SKIN REFLEX,

CRESMATERIC, ANAL, BULBOCAVERNOUS

PATOLOGIC REFLEX : BABINSKI, CHADDOCK,

HOFFMANN – TROMMER, REGRESSION
SUBSPECIALTIES IN NEUROLOGY

NEUROPEDIATRIC OR
DEVELOPMENTAL NEUROLOGY
NEURO-RADIOLOGY
NEURO-PHYSIOLOGY
NEURO-PSYCHOLOGY
NEURO-ANATOMY
NEURO-REHABILITATION
CEREBRO-VASCULAR DISEASE (CVD)
CNS INFECTION
EPILEPSY
PERIPHERAL NERVE
NEURO-OPHTHALMOLOGY
SIGN AND SYMPTOMS IN
NEUROLOGICAL
DISEASES
Due to location
Cerebral
Hemisphere Cerebellum
Brain section
Central Nerves System
Cervical
Medulla Thoracal
spinalis
Lumbosacral

Nucleus

Peripheral nerves system Ganglion

Nerve root
SYMPTOMS & SIGNS
Cardinal symptoms

General cerebral disorders

 High intracranial pressure

Consciousness  Intoxication

 Metabolic disorders

Focal cerebral disorders

 Disturbances of ARAS /
brain stem
 Causes of decreased LOC

Intra-cranial Extra-cranial

Diffuse Focal Hepar

Meningitis, Stroke, Renal

Encephalitis Tumour, Lungs
Abscess
Diabetes
Intoxication

Lumbal
CT-Scan
puncture

Laboratory
Cardinal symptoms

Meningeal irritation : - Infection

- Haemorrhage

- Radix irritation
 Cerebral : hemiparese, hemiplegy
- Vascular
- Infection
Motor dysfunction : - central - SOL
- Degenerative process

Medullar : segmental paralytic

- Upper motor / central

 Hypertonic / spastic

 Hyperreflexia

 Pathological reflex
 Cranial nerve

- Perifer

Segmental : - Myotomal
- Radiculopathy
- Neuropathy
- Lower motor :

 Hypotonic / flacid

 Hypo / areflexia
Sensoric dysfunction :
 Exteroceptive
 Pain
 Temperature
 Touch
 Proprioceptive
 Vibration
 Deep pain
 Position
 Cerebral
 Cortical
 Thalamic
 Medullar
 Radicular
 Organic
Autonomic :

 Symphatic Regulation of blood pressure,

respiration, micturation, bowel
 Parasymphatic habit, sweating
Equilibrium :

 Central :

 Cerebellum

 Posterior medulla spinalis

 Peripheral :

 Vestibular
Higher Cortical Dysfunction :
 Cognitive dysfunction
 Neurobehaviour
 Memory
 Immediate
 Recent
 Long term memory
 Language
 Verbal
 Non verbal
 Dyslexia
 Dysgraphia
 Orientation
 Time
 Place
 Person
 Praxis

 Calculation

 Insight

 Executive function

 Visuospatial

 Emotion
Higher Cortical Dysfunction :

 Degenerative  Dementia

 Vascular  Stroke

 SOL  Intracranial tumor

 Neurotransmitter  Psychiatric disorder

Symptoms :

 Memory problem

 Executive dysfunction

 Language dysfunction, aphasia

 Disorientation

 Disinhibition

 Behaviour disturbances

 Dispraxia