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Ilmu Penyakit SarafDr. Sri Harso M.kes Sp.S
GCS• E
• Spontaneous................ 4
• To Speech.................... 3
• To pain....................... 2
• Nil............................... 1
• M
• Obeys........................... 6
• Localized...................... 5
• Withdraws.................. 4
• Flexion (decorticate) … 3
• Extension (decerebrate). 2
• Nil.................................. 1
• V
• Oriented......................... 5
• Confused conversation .... 4
• Inappropriate words....... 3
• Incomprehensible sound .. 2
• Nil............................... 1
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Stroke
is a neurological impairment caused by adisruption in blood supply to a region of the brain.
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Shiriraj skore
Iskemik
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Stroke hemorrahage
ICH
SAH
INTRA CEREBRAL HEMORRAHAGE
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SUB ARACHNOID HEMORRAHAGE
*KAKU KUDUK
*ANEURISMA(AVM)
*THUNDERCLA P HEADEACHE
*MENINGEALIRRITATION
*VOMITUS
PERBEDAAN SH & SNH
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TROMBOLITIK
• Onset < 3 jam – jika diberikan segera outcomelebih baik
• Stroke onset = dari saat terakhir tampak normal
• Jangan diberikan jika glukosa darah185/110
• Risiko kecacatan 30% walaupun 5% risikoICHsimtomatik
< 3 jam 1. Merupakan batas mutlak2. Tidak ada batasan luas lesi3. Dapat diberikan pada pasien ygs ebelumnya
riwayat penggunaan warfarin dan INR 80 tahun• •NIHSS > 25 • •DM, riwayat stroke sebelumnya• •Riwayat pemakaian warfarin
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Anti trombotik
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Antihipertensi pada Stroke Iskemik Akut
• target penurunan sekitar 15%
• Diberikan apabila TDS >220 atau TDD >120
Pada yang akan diberi terapi trombolitik:1. Target TDS
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SECONDARY PREVENTION
Prevention Life style Modification
Blood Pressure Lowering
•Semua pasien stroke/TIA mendapat obat antihipertensikecuali terdapat symptomatic hypotension
Antiplatelet Therapy
Long-term antiplatelet therapy diberikan pada semua penderitastroke iskemik/TIA yang tidak mendapat terapi antikoagulan•Dapat diberikan Aspirin+dipyridamole(atau aspirin saja pada pasien yang alergi dipyridamole) ATAU Clopidogrel
Anticoagulation Therapy
Diberikan pada penderita stroke iskemik/TIA yang memiliki atrial fibrilation/cardioembolic stroke
Cholesterol lowering
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BELL’S PALSY
PERIFER VS CENTRAL
PERIFER CENTRAL
Atas bawah
Ipsilateral
Bawah
Contralateral
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Grand Mal
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Antiepileptic Drugs
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TREATMENT RECOMMENDATION
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Cerebrospinal Fluid
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• paroxysmal attacks of severe,short, sharp, stabbing pain→affecting one or moredivisions of the trigeminal nerve
Precipitated by : chewing,speaking, washing the face, tooth- brushing, cold winds, or touchinga specific “trigger spot”(e.g. Upperlip or gum)
Etiology :• Many remains unexplained• Compression of the nerve root
• by tumors of thecerebellopontine angle
• Demyelination
Trigeminal Neuralgia
Investigation : •CT/MRI to exclude a cerebello-pontine anglelesion
Management : •Carbamazepine (600-1600mg/day)•Nerve block •Trigeminal ganglion/root injection withalcohol/phenol•Microvascular decompression•Radiofrequency thermocoagulation
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migrain
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Migrain
Cluster Headache
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Lewy body• Lewy bodies are concentric, eosino philiccyto
plasmicin clusions (SCI) with peripheral halosand dense cores.
• Present within pigmented neurons of substantianigra.
• Characteristic of PD but not pathognomonic
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Inbalance
between
Dopamine
vsAcetylcholine
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Agents that Increase Dopamine
functions• Increasing the synthesis of dopamine -l-Dopa • Inhibiting the catabolism of dopamine (MAO-B
Inhibitor)-selegiline • Stimulating the release of dopamine -
amphetamine • Stimulating the dopamine receptor sites
directly(Dopamin agonist)- bromocriptine&pramipexole
• Blocking the uptake and enhancing the release ofdopamine -amantadine
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anopsia
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Myastenia Gravis
VERTIGO: Perifer vs Sentral
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DIX-HALLPIKE MANEUVER
EPLEY
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Reclined head hanging 45 degree turn
Rotate 45 degrees contralateral
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Head and body rotated to 135degrees from supine
Keep head turn and to sittingTurn forward chin down 20 degrees
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BRANDT & DAROFFEXCERCISES
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Medikamentosa
Calcium Channel Blocker
Antihistamin
Histaminik
Mengurangi aktivitas ekstatori SSP dengan menekan pelepasanglutamat, meningkatkan aktivitas NMDA sepcific channel, dan bekerja langsung sebagai depressor labirin. Bisa untuk vertigoperifer dan sentral.
Efek antikolinergik dan merangsan inhibitory-monoaminergik,dengan akibat inhibisi n. Vestibularis
Inhibisi neuron polisinaptik pada n.vestibularis lateralis
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HNP
dermatom
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laminectomy
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Plexus Brachialis
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• Superior Trunk (C5-C6)Injury:
• Antaraleherdgnbahuteregang→Erb-DuchennePalsy(Waiter’s Tip)
• → Paralisism. deltoid, biceps, brachialis,danbrachioradialis.
• → Adduksibahu, rotasimediallengan, danekstensisiku.Parestesialateral upper limb .
• Inferior Trunk (C8-T1) Injury:
Tarikanmendadak dankerasupper limb→ KlumpkePalsy→Claw hand
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• The most common focal
peripheral neuropathy,results from compression ofthe median nerve at the wrist.Clinical Features:
1. Pain2. Numbness3. Tingling4. Symptoms are usually worse
at night and can awaken
patients from sleep.5. To relieve the symptoms,
patients often “flick”their wrist as if shaking down athermometer (flick sign).
CARPAL TUNNEL SYNDROME
• Phalen’s maneuver (fleksi tangan secara maksimal
dalam 60 detik timbul gejala→CTS +)• Tinel’s sign (posisi tangan sedikit dorsofleksi perkusi
carpal tunnel parestesia atau nyeri pada daerahdistribusi nervus medianus +)
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• nerve conduction study (NCS) is a medicaldiagnostic test commonly used to evaluate thefunction, especially the ability ofelectrical conduction,
of the motor and sensory nerves of the human body.
• nerve conduction study (NCS)
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Nice to know
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