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Similar to dr. Yusmahenry Galindra, Sp.S Neuropati,pain, pemriksaan emg minggu ke 3.pptx
Similar to dr. Yusmahenry Galindra, Sp.S Neuropati,pain, pemriksaan emg minggu ke 3.pptx (20)
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dr. Yusmahenry Galindra, Sp.S Neuropati,pain, pemriksaan emg minggu ke 3.pptx
- 1. Dr Yusmahenry Galindra SpS Fakultas Kedokteran Uniba Batam
- 3. Neuropati Proses patologi yang mengenai susunan saraf perifer, berupa proses demielinisasi atau degenerasi aksonal atau kedua-duanya. Sususan saraf perifer mencakup saraf otak, saraf spinal dengan akar saraf serta cabang- cabangnya, saraf tepi dan bagian-bagian tepi dari susunan saraf otonom
- 4. Spinal nerve anterior Horn med spinal Distal peripheral nerve Cranial nerve Otonomic nerve Distribusi dari gangguan saraf peripheral :
- 5. Anamnesa Sensorik, motorik, otonom Onset, serabut sarat terkena,lokasi, derajat PF LMN, fasikulasi,atropi EMG, KHS, LAB, MRI
- 6. Metabolik Nutrisi toxic keganasan trauma autoimun Neuropati DM PN def asenik MM, LM Etramnent GBS PN DM piridioksin GIT ataxia jebakan otonom asam folat mononeupati niasin Polinueurpati PN Merkuri Uremicum Alkohol Note PN : poly neuropati
- 7. Neuropathy It is condition where perifer nerve gets dysfunction and distruction. Clinical manifestation of lower motor neuron paralysis included : Sensory Negative phenomenon : Hypestesia, the loss of sense, pain, temperature and deep sense Positive phenomenon : paresthesia hiperalgesia incomportable, burning sensation Clinical symptom : Distal gloves stocking hypesthesia Dermatomel
- 8. Motoric Weakness from light to severe especially distal Loss of tendon reflex Autonomic Example : Cool on limb Postural syncope Orthostatic hypotension Hyperhidrosis Neuropathy ( cont’d )
- 9. Neuropathy It is condition where perifer nerve gets dysfunction and distruction. Clinical manifestation of lower motor neuron paralysis included : Sensory Negative phenomenon : Hypestesia, the loss of sense, pain, temperature and deep sense Positive phenomenon : paresthesia hiperalgesia incomportable, burning sensation Clinical symptom : Distal gloves stocking hypesthesia Dermatomel
- 10. Motoric Weakness from light to severe especially distal Loss of tendon reflex Autonomic Example : Cool on limb Postural syncope Orthostatic hypotension Hyperhidrosis Neuropathy ( cont’d )
- 11. Peripheral nerve disorder LMN Polyneuropathies Mononeuropathies Approach Acute Subacute chronic Guillain Barre Syndrome Vitamin deficiency amyloidosis metabolic Trauma Pressure: CTS Leprosy
- 12. Principal Neuropathic Syndrome I. Syndrome of acute motor paralysis with variable disturbances of sensory and autonomic function Guillain Barre Syndrome ( GBS ) II. Syndrome of sub acute sensorimotor paralysis A. Symmetrical polyneuropathies Vitamin deficiency B. Unusual sensory neuropathies Diabetic neuropathies C. Polyradiculopathy
- 13. Principal Neuropathic Syndrome III. Syndrome of chronic sensorimotor polyneuropathy A. Less chronic, acquired forms CIDP B. Syndrome of more chronic polyneuropathy Inherited polyneuropathy C. Inherited polyneuropathy of mixed sensorimotor types IV. Neuropathy associated with mitochondrial diseases V. Syndrome of recurrent or relapsing polyneuropathy VI. Syndrome of mononeuropathy or plexopathy Cont’d
- 14. MONONEUROPATHY Entrapment neuropathies Trauma Every cause listed under multiple mononeuropathies(below) may start with single nerve involvement MULTIPLE MONONEUROPATHIES Hereditary liability to pressure palsies Vasculitic neuropathy Diabetic mononeuropathies and lumbosacral radiculoplexus neuropathy Sarcoid Leprosy Multifocal motor neuropathy AIDS Tangier disease Focal variant of chronic inflammatory demyelinating polyradiculoneuropathy (may affect one or more nerves of a limb)
- 15. SYMMETRIC POLYNEUROPATHIES Inflammatory/Immune-Mediated Neuropathies Guillain Barres Syndrome Chronic inflammatory demyelineting polyradiculoneuropathy Vasculitic neuropathy Sarcoid neuropathy Neuropathies associated with connective tissue disease Toxic Neuropathies Drugs, metals, alcohol Inherited Neuropathies Hereditary motor sensory neuropathies Giant axonal neuropathy Hereditary sensory and autonomic neuropathies Peroxisomal disorder (adrenomyeloneuropathy, refsum disease) Porphyric neuropathies Lipoprotein disorders (Tangier disease, abetaliproteinemia) Lysosomal enzyme deficiency (Fabry disease)
- 16. SYMMETRIC POLYNEUROPATHIES (cont’d) Vitamin Deficiensies Cobalamin, vitamin E, thiamine Neuropathies Associated with Cancer Remote effects of cancer Direct tumor infiltration Paraproteinnemia-Related Neuropathies Diabetic Polyneuropathy Neuropathies Associated with Organ System Failure Kidney, lung, liver Critical illness polyneuropathy Neuropathies associated with organ transpalntation Neuropathies Associated with Infection HIV Leprosy Lyme disease Table. 1. Anatomic Distribution of Neuropathies and differential Diagnosis
- 17. Klinis : Gangguan sensorik : parestesia, nyeri, terbakar, penurunan rasa raba, vibrasi dan posisi. Gangguan motorik : kelemahan otot-otot – reflek tendon menurun - fasikulasi Laboratorium : - Gula darah puasa, fungsi ginjal, kadar vitamin B1, B6, B12 darah, kadar logam berat, fungi hormon tiroid - Lumbal pungsi : sesuai indikasi Gold Standard : - ENMG : degenerasi aksonal & demielinisasi - Biopsi saraf
- 18. Terapi kausa - Simptomatis : analgetik, antiepileptik - Neurotropik vitamin : B1, B6, B12, asam folat - Fisioterapi
- 20. Somatoform disorder Dorsal radiculopathy Myelopathy A few axonal neuropathies with sensory predominance “ Recovered “ Guillain-Barre syndrome IgM monoclonal gammopathy Rare cases of active Guillain- Barre syndrome, chronic inflammatory demylinating polyradicaloneuropathy, and the Fisher syndrome Friedreich’s ataxia Idiopathic sensory neuropathy Carcinomatous sensory neuropathy Sjögren’s syndrome with ataxic neuropathy Some neurotoxic disorders Normal electrodiagnostic studies Axonal sensorimotor neuropathy Demyelinating neuropathy Pure sensory fiber loss Fig. 1. Electrodiagnostic differentiation of ataxic neuropathies
- 21. Polineuropati adalah penyakit saraf atau kerusakan dari beberapa saraf pada saat bersamaan.
- 22. Gangguan gerakan (saraf motorik) dan indera (saraf sensori) terjadi pada kedua sisi tubuh. Munculnya rasa sakit (sensasi terbakar, dingin, tersengat) atau sensasi lainnya (gatal, pembengkakan) Merasa kebas atau sakit pada telapak kaki, betis dan paha, jari-jari, tangan, dan lengan. Kaki melemah Kemampuan pergerakan mata terganggu.
- 26. Peripheral nerve spread out in all of body Characteristic lower motor neuron Paralysis depend lokasi derajat fiber nerve Onset disorder