BASIC DIAGNOSIS NEUROLOGY(DASAR-DASAR DIAGNOSISTOPIS NEUROLOGI)

Anwar Wardy WJakarta, 24 Mei 2006

anwar wardy w.06

Neuro-Ophthalmology Eye Neurologic Exam Oculocephalic Reflex Nystagmus

Face Exam Cranial Nerve Exam Palpebral fissures equal Facial symmetry Tongue midline with no fasciculations Jaw symmetric

anwar wardy w.06

Cranial Nerve

Cranial Nerve I Cranial Nerve II Cranial Nerve III Cranial Nerve IV Cranial Nerve V Cranial Nerve VI Cranial Nerve VII Cranial Nerve VIII Cranial Nerve IX Cranial Nerve X Cranial Nerve XI Cranial Nerve XII

anwar wardy w.06

Refered Pain (Angina Pectoris)

anwar wardy w.06

Oropharynx Exam Gag Reflex Swallow reflex Regurgitation (nasal or liquid) Larynx and Language Voice quality Speech Exam Dysarthria (explosive or nasal) Aphasia (writing)

anwar wardy w.06

Sensory Two Point Discrimination Sharp and dull discrimination Proprioception (finger up or down?) Stereography Motor Exam Motor Strength Tone (flaccid, rigid, or cogwheel) Atrophy Fasciculations Muscle tenderness Tremor

anwar wardy w.06

Sensory Exam

Agnosia Diabetic Neuropathy Testing Two Point Discrimination

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Motor Exam :

Movement Disorder Reflex Exam Tetany Acute Motor Weakness Causes Hemiplegia Left Hemiplegia Right Hemiplegia

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Sign of UMN LessionWeaknessIncreased tone (spasticity)Atrophy of disuse onlyIncreased deep tendon reflexes.Extensor plantar response (Babinski)

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Sign of LMN LessionWeaknessDecreased tone (flaccidity)AtrophyFasciculationsDecreased to absent deep tendon reflexes

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Reflexes Deep Tendon Reflexes Primitive Reflexes Babinski Reflex Grasp Reflex Suck Reflex Glabellar Reflex Hoffman Reflex

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Reflex Tendon

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Gait

Walking on base of foot Tandem walking Overall coordination

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Cognitive :

Aphasia Apraxia Executive Function Disturbance Higher Integrative Functions Memory Evaluation Mental Status Exam

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Afasia;

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Cognitive Examination

Mini-Mental State Exam Mental Status Consolidated Screening Time and Change Test Clock Drawing Test Neuropsychiatric Inventory Questionnaire Confusion Assessment Method

anwar wardy w.06

Cerebrovascular Accident NIH Stroke Scale Los Angeles Prehospital Stroke Screen Dysphagia Evaluation Neuro-Otolaryngology Cavernous Sinus Dysphagia Gag Reflex Dysarthria

anwar wardy w.06

Infectious Disease Meningeal Irritation Opisthotonos

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Level of Consciousness Level of Consciousness Coma Exam Glasgow Coma Scale Decorticate posturing

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Bells Bell's Palsy Facial Nerve Paralysis Causes Infectious Disease Herpes Ophthalmicus Ramsey Hunt Syndrome Assorted Pages in Cranial Nerve Progressive Bulbar Paralysis Trigeminal Neuralgia

anwar wardy w.06

Evaluasi otak sekarang dan akan datang!Berbagai generasi alat bantu untuk mengevaluasi Otak; secara fungsional; (maupun Struktur/Anatomi) a. EEG. b. A.Scan & B Scan C. CT.Scan. d. MRI (Magnetic Resonance Imaging) e. PET Scan (Positron Emission TomoG) f. MEG (MagnetoEncephaloGrams) g.TCD (TransCranial Doppler) h. Evoked Potensial EEG Brain Mapping.

anwar wardy w.06

Other-line in Examination Neurologic Exam Oculovestibular Testing Cerebral Spinal Fluid: (gbr Tap Spinal)Neurovascular Anatomy Headache

anwar wardy w.06

EEG

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Philosophical Approach EEG.EP-Brain MappingAnalisa Spektrum Pewarnaan Otak, selama potensial otak yang ditimbulkan dapat dilihat dan dicatat/data sesuai fungsi otak saat itu.Peta (maps) dari potensial yang ditimbulkan (EP) dan EEG secara bersama (akurat) diinterpretasi sesuai poligrafik data EEGdata yang dihasilkan mulai dari data Normal sd Abnormal (data deteksi awal)Data awal (raw data) dan peta adalah ilustrasi primer sebagai hasil analisa Brain Neurologist atau Physiologist .

anwar wardy w.06

Clinical AspectsDrug Abuse.EncephalitisMyocardial InfarcSevere headachesCancerAbnormal AuditionMental Retard

Genetic AbnormalClinnical DepresionHypertensionSevere Head InjuryComaStrokeAbn.Pulmonary FuctionAbn.Hepatic FucntionAbn.Vision.Kelainan Pembelajaran.PsychiatricSchizopreniaAlkoholsMeningitisEpilepsy

anwar wardy w.06

Brain Mapping;Brain mapping is a technique to display EEG data. A circle represents the head. Each electrode is projected to a position on the circle depending on the co-ordinates of the electrode. The EEG data at each electrode is evaluated and an interpolation is used to gain a value for every point on the circle;

anwar wardy w.06

Problem:Pemetaan Otak adalah suatu jalan/cara untuk mengkhayalkan distribusi potensial/tenaga didalam otak melalui 4 EEG jalur (alpha, beta, theta, delta wave), electrode diatas tengkorak. Bagaimana mungkin peta individu diuji melawan aspek pemikiran orang yang diperiksa. Umur yang didasarkan pada, Pola rekaman dan penemuan klinis EEG individu data mungkin adalah digolongkan kelompok data. Dibanding EEG individu, peta otak mungkin akan diuji melawan terhadap peta otak kelompok spesifik; untuk dibandingkan.

anwar wardy w.06

CVD; topis GPDO

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Profile IllnessRelentlessly Progressive: -Neoplastic disease -Degerative disease.Stepwise: -Vascular disorders -Collagen disorders -Immunological disorders.Sudden Onset: Infection and Vascular disease.Intermittent, relapsing: Demyelinating and vascular disease.

anwar wardy w.06

Th .UWassalamuAlaikum Wr, Wbr.FKK-UMJ

anwar wardy w.06