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NEUROPATI

Penjelasan secara umum mengenai Neuropati

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NEUROPATI

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  1. NEUROPATI

  2. NEUROPATI DEFINISI : • Proses patologik sistem saraf perifer yang menetap (lebih beberapa jam) berupa degenerasi axonal / demyelinasi atau gabungan dengan gejala gangguan motorik, sensorik dan otonom, ditandai menurunnya refleks tendon. • Sistem saraf perifer: saraf otak, saraf spinal, saraf otonom dengan akar saraf serta cabang cabangnya.

  3. Basics of EP, EMG and NCS Nervous System • Your nervous system is composed of the central nervous system, the cranial nerves, and the peripheral nerves. • The network of nerves that connect at different levels of the spinal cord control both conscious and unconscious activities. • It is through the spinal cord that information flows from these nerves to the brain and back again.

  4. POLINEUROPATI : • Neuropatidengan kelainan simetris/ bilateral sistem saraf perifer, mula mula distal kmd menyebar ke proksimal. • Kelainan dpt berbentuk motorik, sensorik, sensomotorik atau autonomik.

  5. MONONEUROPATI : • Fokalbilamana mengenai satu akar saraf perifer • Multifokal / multiplek bilamana mengenai beberapa saraf perifer dari akar yang berlainan dan umumnya asimetris

  6. KLASSIFIKASI Beberapa parameter dipakai sebagai dasar pembagian • Gejala utama : motorik, sensorik, autonomik atau gabungan 2.Distribusi : - simetrikal, asimetrikal. - distal, general - polineuropati, mononeuropati fokal / multiplex 3.Perjalanan penyakit : - akut, subakut, kronik, kumat-kumatan 4.Patologik : - aksonopati, mielinopati, gabungan 5.Etiologi : inflamasi, metabolic, nutrisi dll.

  7. BERDASARKAN GAMBARAN EMG A. MONONEUROPATI 1. FOCAL : COMPRESSION ENTRAPMENT 2. WIDESPREAD : SUBCLINICAL NEUROPATHY (DIABETES) B. MONONEUROPATHY MULTIPLEX 1. AXONAL : DIABETES, LEPROSY 2. DEMYELINATING : VARIANT CIDP C. POLYNEUROPATHY • AXONAL (DEFISIENSI, TOXIC, DIABETES, CARCINOMA, HMSN) 2. DEMYELINATING (GBS, CIDP)

  8. KAUSA • Inflamatory Guilain-Barre Syndrome (GBS) Chronic inflammatory demyelinatingpolyradiculo-neuropathy (CIDP) • Metabolic Diabetes, Renal Disease • Nutritional deficiencies Folic acid, Vit B1, Vit B6, Vit B12, Vit E • Toxic Drug, Alcohol, Lead • Connective tissues Disease Systemic lupus erythematosus Rheumathoid arthritis Polyarteritis

  9. Malignancy Bronchus, Breast, Myeloma • Hereditary HMSN syndromes • Trauma Entrapment mononeuropathies Limb injuries • Infection Leprosy, Diftery LYME HIV, EB-VIRUS, HEPATITIS, CM-VIRUS

  10. II. DANG THERAPIST D IABETES MELLITUS A LKOHOL N UTRIONAL G UILLIAN BARRE SINDROM T RAUMA H EREDITER E NDOKRIN / ENTRAPMENT R ENAL / RADIASI A IDS / AMILOID P ARAPROTEIN / PORPHYRIA I NFECTION (MISALNYA LEPROSY) S ISTEMIK / SARKOID T OKSIN

  11. III. NEUROPATHY SPESIFIK 1. INFLAMATORY DEMYELINATING POLYNEUROPATHIES GBS, CDIP 2. PENYAKIT CHARCOT- MARIE-TOOTH (CMT) 3. CRANIAL NEUROPATHIES A. CRANIAL NEUROPATHIES SINDROM 1. CAVERNOSUS SINUS SYNDROMES 2. BASILAR MENINGITIS 3. JUGULAR FORAMEN SYNDROMES 4. POLINEURITIS KRANIALIS : VARIANT GBS 5. MIASTENIA GRAVIS 6. BOTULISME B. BELLS PALSY

  12. 4. NEUROPATI DIABETIK A. DIFFUSE NEUROPATHY 1. DISTAL SYMMETRIC SENSORIMOTOR POLYNEUROPATHY 2. AUTONOMIC NEUROPATHY a. SUDOMOTOR NEUROPATHY b. CARDIOVASCULAR AUTONOMIC NEUROPATHY c. GASTROINTESTINAL NEUROPATHY d. GENITOURINARY NEUROPATHY 3. SYMMETRIC PROXIMAL LOWER LIMB MOTOR NEUROPATHY (AMYOTROPHY) B. FOCAL NEUROPATHY 1. CRANIAL NEUROPATHY 2. RADICULOPATHY / PLEXOPATHY 3. ENTRAPMENT NEUROPATHY 4. ASYMMETRIC LOWER LIMB MOTOR NEUROPATHY (AMYOTROPHY)

  13. 5. PLEXOPATI A. BRACHIAL PLEKSOPATI B. LUMBOSAKRAL PLEKSITIS 6. NEUROPATI JEBAKAN DAN TRAUMA SARAF TRAUMATIK A. -AKTIFITAS BERULANG ULANG : MENGETIK - PENYAKIT SEBELUMNYA : ALKOHOLISME, DM, HIPOTIROIDISM, AKROMEGALI, ARTRITIS, KANKER, TRAUMA JEBAKAN. B. TRAUMA PLEKSUS BRAKIALIS C. SINDROMA JEBAKAN • JEBAKAN NERVUS MEDIANUS • JEBAKAN NERVUS ULNARIS • JEBAKAN NERVUS RADIALIS • THORACIC OUTLET SYNDROME • MERALGIA PARESTIKA • NERVUS PERONEAL PALSY (N. CUT. LAT. FEMORALIS) • TARSAL TUNNEL SYNDROME (N. TIBIALIS POSTERIOR)

  14. GEJALA DAN TANDA • GEJALA : • Ekstremitas bawah • Sensorik : • Rasa baal sesuai distribusi kaos kaki (Stocking Appearance) • Rasa goyah bila berdiri atau berjalan terutama bila mata tertutup • Motorik : • Foot drop • Kesulitan naik tangga atau berlari

  15. Ekstremitas atas : • Sensorik : • Rasa baal sesuai distribusi sarung tangan (Glove Appearance) • Kesulitan memanupulasi obyek kecil dijari tangan karena kehilangan sensasi . • Motorik : • Kelemahan jari jari dan menggenggam

  16. TANDA : • Ekstremitas bawah • Sensorik : • Gangguan modalitas sensoris mengakibatkan hipaestesi sesuai distribusi stocking. • Tampak ataksia tungkai dan saat berjalan (test Romberg +) • Motorik : • Tanda LMN pada tungkai (kelemahan tipe flaxid, hipotoni, atrofi, refleks tendon menurun / menghilang)

  17. Ekstremitas atas • Sensorik : • Gangguan modalitas sensoris mengakibatkan hipaestesi sesuai distribusi glove • Tampak ataksia jari-jari dan tangan • Motorik: • Tanda LMN pada lengan • Refleks tendon menurun / menghilang

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