k8 - Prosedur fwrtgfwfDiagnostik 2012

8/11/2019 k8 - Prosedur fwrtgfwfDiagnostik 2012

1/45


2/45

HISTORY TAKING

NEUROLOGICAL EXAMINATION

DIAGNOSISFURTHER EXAMINATION : LAB, LP,

EEG, EMG, RADIOLOGIC, BIOPSY

FINAL DIAGNOSIS


3/45

PEM. LABORATORIUM FOTO RONTGEN

SKULL SERVIKAL : AP, LAT, OBLIQ THORAKAL: AP, LAT LUMBOSAKRAL: AP, LAT, OBLIQ

CT SCAN, MRI, MRA, PET, SPECT, DLL

LUMBAL PUNGSI EEG, EMG. EVOKE POTENSIAL,DLL


4/45

SKULL- FRAKTUR- MALFORMASI KONGENITAL- GANGGUAN PERKEMBANGAN

SPINE- FRAKTUR

- TUMOR TULANG- PENYAKIT DEGENERATIF- INFEKSI YANG MELIBATKAN TULANG


5/45


6/45

STRUKTURAL / ANATOMIS CT SCAN, MRI,MYELOGRAFI, DLL

FUNGSIONAL EEG, EMG, EVOKE POTENSIAL

METABOLISME PET, SPECT

BLOOD VASCULATURE ANGIOGRAFI, MRANGIOGRAFI, TCD


7/45


8/45


9/45

COMPARATIVE INDICATIONS OF CT MRILocation and type of pathology CT MRI

Brain atrophy +++ +++Acute infarct ++ +++Older infarct ++ +++Lacunar state +++ +++

Intraparenchymal hemorrhage ++ +++Subarachnoid hemorrhage +++ +Aneurysm + ++Venous thrombosis + +++Brain tumor (cerebral hemispheres) ++ +++Pituitary tumor + +++


10/45

INDIKASI Diagnosis meningitis, ensefalitis, dll Perdarahan sub arachnoid, intra serebral Meningeal karsinomatosis Mengukur tekanan intra kranial Kemoterapi intrathecal Drainase / reduksi cairan likuor (pada hidrosefalus

communican Respon terapi


11/45

Diduga peninggian intra kranial ok SOL HerniasiInfeksi lokal dekubitusKadar trombosit < 40.000

Protrombin time < 50 %Penyakit /gang. jantung, pernafasan yg beratMassa pada spinal kord(kecuali utk Dx LP yang diikuti myelografi)


12/45

Sakit kepala (post lumbal puncture headache) Hematoma epidural / subdural Infeksi Herniasi Traumatic tap


13/45

Pasien dibaringkan dgn posisi miring pada piggir tempattidur.Leher badan badan paha lutut FLEKSILokasi LP L4-L5 (setentang SIAS ), atau L2-L3Kulit dibersihkan dgn jodium, bilas dengan alkohol, berianastesi lokalTusukkan jarum sejajar dgn garis tlg belakang dengansudut 10 20 0 arah kepala, sampai menembus duramater.


14/45

Gambaran aktivitas listrik otak/potensial listrik otak

Grafik Elektroensefalogram

Prosedur pembuatan grafik Elektroensefalografi

Sumber gelombang yang utama Kortek

Electrodes are placed on the scalp according to theinternationally standardized 1020 system


15/45

Singkatan dari: Electroencephalogram Electroencephalographic Electroencephalography

CAA/FEB/09


16/45

Definisi:Rekaman listrik otak yang direkamoleh elektroda yang ditempatkan padakulit kepala

CAA/FEB/09

Electro- listrikEncephalo-otakGram(ma)-gambar


17/45

Definisi : Rekaman Bioelektrik

ELECTROENCEPHALOGRAPHYDefinisi:

Ilmu yang mempelajari aktivitas listrik otakTehnik melakukan rekaman & menginterpretasi -kan

suatu electroencephalogram

CAA/FEB/09


18/45

CAA/FEB/09

Neuron padakorteks otak

Perubahan potensiallistrik

GelombangALPHA (8 -13 Hz)BETA (>13Hz)THETA (4 -7 Hz)DELTA(


19/45

Diagnosis & klasifikasi kejangEnsefalopati, EnsefalitisBrain death

Pengukuran & prognosis kejangDeteksi lesi otak struktural tumor serebri ,traumakapitisGangguan metabolik, fisiologik di otakDLL


20/45


21/45

DASAR-DASAR ANALISA EEG Umur, keadaan klinis, pemakaian obat, indikasi EEG Komposisi gelombang EEG & topografinya

Gambaran EEG simetris / asimetris Perubahan aktivitas EEG selama rekaman denganadanya stimulus & perubahan kesadaran (mengantuk,tidur, PS, HV)

Adanya gelombang abnormal spt, spike, dll


22/45

Parameter utama hubungan frekwensi/voltaseMacam-macam gelombang

Alfa : 813 spd, anak lanjut, dewasa, mata tertutup Beta : > 14 spd, 25 uV, frontal Teta : 4 7 spd, mengantuk, tidur Delta : < 4 spd, tidur, sadar abnormal Spike : 27 70 ms duration

Sharp wave : 70 200 msSpike sharp wave Epileptipform wave


23/45

GAMBARAN ABNORMAL SPESIFIKSpike komplek, 3 spd, diffuse bilateral, sinkron &simetris ( Petit mal )Spike wave, bilateral, sinkron & diffuse (Grandmal

idiopatik )GAMBARAN ABNORMAL NON SPESIFIK

Tumor otak perlambatan fokal, DeltaTrauma kapitis perlambatan, penurunan voltase

diffuse, sesuai luasnya lesiMeningitis,ensefalitis,metabolik ensefalopati


24/45

Suatu tindakan untuk merangsang timbulnya aktivitasEEG abnormal, dapat berupa

Stimulus fotik Hiperventilasi Rekaman tidur


25/45

Aktivitas listrik otot menusukkan elektroda jarumpada otot

Elektromyogram gambaran khas pada otot istirahat /aktif dan memberikan gambaran abnormal sesuaikelainan level motor unit


26/45

Prinsip : membedakan lesiSaraf Motor neuron

Akson

Sambungan saraf ototOtotHasil interpretasi tidak memberikan diagnosa klinisspesifik, tetapi membantu menegakkan diagnosa,bersama pemeriksaan klinis,dll


27/45

Motor neuron diseaseGangguan saraf tepi & akson ( neuropati )Gangguan pada neuromuskular junction(miastenia gravis)Penyakit otot primer ( DMP )Membantu menegakkan diagnosis seperti BellsPalsy

DLL


28/45

Motor nerve conduction studies mencatat responelektris dari otot terhadap stimulasi saraf motoriknyapada 2/lebih, sehingga dapat ditentukan kecepatanpenghantaran serabut motorik pd 2 tempat stimulasi(MCV).

Sensory nerve conduction studies mengukurkecepatan hantaran saraf & amplitudo action potensialpada serabut sensorik ( KHS )


29/45

MYELOGRAPHYBy injecting 5-25ml of radiopaque dye(iopamidol/ isovue) through a lumbar punctureneedle.

The entire spinal subarachnoid space can bevisualized.Useful in visualizing small areas within the spinalcanal.


30/45

CT body scan :- provides excellent images of the spinal

canal & intervertebral foramina visualizingspinal & posterior fossa lesions


31/45

MRI has largerly replaced contrast myelographybecause:- does not require lumbar puncture- provides sharper visualization of the spinal

canal & its contents.- image lesion greater clarity


32/45

EVOKED POTENTIALS

Assess the integrity of individual functionalsystems (visual, auditory, somatosensory, ormotor).Activated with a repeatedly delivered stimulus.Provide evidence of whether impulse conductionin the system in question is intact from the site ofstimulation all the way to the cerebral cortex.

May reveal subclinical lesions


33/45


34/45

POSITRON EMISSION TOMOGRAPHY (PET)

Measured the cerebral concentration ofsystematically administered radioactive tracers.Measured local patterns of cerebral blood flow,oxygen uptake, glucose utilization.NoninvasivelyTomographic images are constructed bytechniques similar to those used in CT & MRI.


35/45

Proved to be of value in:- grading primary brain tumors- distinguishing tumor tissue from radiation

necrosis- localizing epileptic foci

- differentiating types of dementing diseases.Has ability to quantitate neurotransmitter & theirreceptors importance in the study of

parkinson disease & other degenerative diseases.


36/45

PET not available for routine diagnosis because:

- found in relatively few medical centers

- requires costly facilities & support staff.


37/45

Single Photon Emission Computed Tomography(SPECT)

Has evolved from PETMeasure regional blood flowDemonstrate reduced perfusion of the brain (instroke or in Alzheimer disease)Detect focal pathological processes of other kinds(epileptogenic foci)


38/45

NORMAL ALZHEIMER DISEASE


39/45

ANGIOGRAPHY

Has evolved over the last 50 years

Relatively safe & an extremely valuable methodfor the diagnosis of :- aneurysms- vascular malformations- narrowed or occluded arteries & veins- arteria dissections- angiitis

A needle is placed in the femoral or brachialartery.


40/45

The great advantages of this procedure are :

- The vessels can be visualized with relativelysmall amounts of dye & that this can beaccomplished with the smaller catheters than

those used in standard angiography.- The arterial route is now used exclusively.


41/45


42/45


43/45

Copyright 2004 American Academy of Neurology43

non-invasive can be performed at the bedside easily repeated or used for continuous

monitoring is generally less expensive than other techniques contrast agents are not used avoiding allergic

reactions and decreasing risk to the patient


44/45

Copyright 2004 American Academy of Neurology44

examination of cerebral blood flow velocities incertain segments of large intracranial vessels

detects indirect effects (abnormal waveformcharacteristics) suggesting of proximalhemodynamic or distal obstructive lesions

more valuable in specific conditions


45/45

Documents

k8 - Prosedur fwrtgfwfDiagnostik 2012