neurology examination pemeriksaan saraf
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pemeriksaan sarafTRANSCRIPT
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Neurologic examination
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Alat-alat Ophthalmoscope Senter Pecussion hammer / hammer reflex Pin Stetoskop
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Anamnesis Umur
Mendasari jenis penyakit Keluhan utama
Yg menyebabkan ps masuk RS Riwayat penyakit sekarang
Onset (akut, kronis) Progresivitas gejala Kronologis
Riwayat penyakit dahulu Faktor risiko/faktor pencetus
Riwayat penyakit keluarga Faktor genetik
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First impressions Ps saat berjalan
Parkinsonian, ataxia gait, hemiparetic gait, scissor gait Postur tubuh
Limb ataxia, terpaksa/tidak Ps saat duduk Raut wajah
Tanpa ekspresi, kesakitan, ptosis, hemifacialparesis Suara
Pelo, sengau, serak Ps saat tiduran
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Pemeriksaan umum Status mental
Kooperatif, orientasi, memori, emosional, halusinasi Kepala dan leher
kaku kuduk, ukuran kepala Kulit (alergi, sianosis, herpes) Jantung (fibrilasi, aritmia, bising) Tekanan darah (hipertensi, hipotensi) Paru (TBC, Ca) dan dada (Ca) Abdomen (Ca gaster, colon dll.) Pelvis (Ca prostat, kehamilan) Limfonodi (NHL, TBC) Tiroid (tirotoksikosis: eksoptalmos, weakness)
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Kesadaran Kualitatif
Composmentis: sadar penuh Somnolen/drowsiness:
• Dg stimulasi bisa sadar penuh Stupor:
• Dg stimulasi hanya bisa respon sesaat Coma:
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Confusion & disorientation:• Pemahaman yg keliru
• Waktu• Tempat• Orang
Delirium:• Mental confusion, exitement, illusions, hallucination
Akinetic mutism:• Apparently awake, lies immobile, no speech/sound,
follow with his eyes Catatonia:
• Lies mute, immobile, unresponsive, not follow with eyes, plastic rigidity of the limbs
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Kuantitatif dg Glasgow Coma Scale
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Saraf Kranial Saraf perifer 12 macam Bisa menunjukkan letak lesi
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Midbrain & cranial nerves
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N. Olfactorius (I) Sensation of smell Cara:
Kooperatif Mata terpejam Hidung bebas
hambatan Dg kopi, tembakau,
teh Lubang dites satu
persatu
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N. Opticus (II) Visus:
Snellen card (6/6) Jari (../60) Lambaian tangan
(…/300) Cahaya (…/~)
Warna (Ishihara)
Visual fields Tes konfrontasi Tes perimetri
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Tes konfrontasi
perimetri
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Pem fundus: Discus (papil edema,
atrofi) Arteri & vena Retina (perdrhan,
eksudat, tuberkel, phakomata)
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N. Oculomotorius (III) Ptosis (klp mata jatuh) Gerakan bola mata
Ke medial, atas, bawah Refleks cahaya (+/-) Ukuran pupil (mm):
Cahaya dari seb lateral mata
Bentuk pupil (isokor/anisokor)
Diplopia (pandangan dobel)
Nistagmus (gangg balans tonus otot bola mata)
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N. Trochlearis (IV) Gerak bola mata
ke lateral bawah Diplopia (pandangan
dobel) Nistagmus (gangg
balans tonus otot bola mata)
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N. Abducens (VI) Gerak bola mata
ke lateral Diplopia (pandangan
dobel) Nistagmus (gangg
balans tonus otot bola mata)
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N. Trigeminus (V) Fungsi:
Sensasi wajah Gerakan
mengunyah Refleks cornea
Sentuhan kapas basah pd limbus cornea
Bilateral blink (+)
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Gerakan mengunyah: Palpasi otot
masseter Buka mulut Jaw jerk (sulit)
Saraf peka nyeri
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N. Facialis (VII) Fungsi:
Gerakan wajah Pengecap 2/3 lidah
depan Sekresi gld
lacrimalis & gld salivarius
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Gerakan wajah: Meringis Tutup mata Kerutkan dahi
Pengecap: Gula, garam, cuka,
kinina Disentuh dg cottonbuds
Sekresi: Inhalasi amonia
(lakrimal) Bumbu yg keras (saliva)
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N. Auditorius (VIII) Fungsi:
Pendengaran (cochlear nerve)
Keseimbangan (vestibular nerve)
Pendengaran: Masking noise Garputala
• Rinne’s test: udara/tulang
• Weber’s test: tulang• Schwabach’s test:
pt/examiner
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Keseimbangan: Rotational test:
• Diputar di kursi 10x selama 20 detik
Caloric test:• Irigasi dg air 250 ml
selama 40 dtk, suhu 30ºC & 44ºC
Romberg test:• Berdiri kaki rapat,
buka & tutup mata
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N. Glossopharyngeus (IX) Fungsi:
Mengatur otot palatum & pharynx
Sensasi di pharynx, tonsil, palatum, lidah blkg
• Refleks muntah Pengecap 1/3 blkg
lidah
Saraf peka nyeri
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N. Vagus (X) Fungsi:
Mengatur otot palatum & pharynx
• Refleks menelan• Disfagia
Sensasi di pharynx, tonsil, palatum, lidah blkg
Mengatur otot pita suara
Saraf peka nyeri
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N. Accessorius (XI) Otot-otot leher Otot-otot bahu
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N. Hypoglossus (XII) Otot lidah Disartria (gangg
artikulasi) Menjulurkan lidah:
mencong Fasikulasi, tremor,
atrofi (tanda perifer)
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Ekstremitas Gerakan Kekuatan Tonus Trofi R. fisiologis R. patologis Clonus
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Kekuatan otot
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Tonus otot Cara pemeriksaan:
Gerakkan otot ps secara pasif, raba tahanan otot yang diperiksa
Trofi otot Cara pemeriksaan:
palpasi masa otot yg diperiksa
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Refleks fisiologis
Refleks patella Refleks achilles
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Refleks patologis Babinski
Hoffmann
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Clonus
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Tanda2 lesi UMN Hipertonus Hiperrefleksi/refleks fisiologis
Reaksi asimetris Perluasan refleks Refleks silang
Refleks patologis + Clonus + Eutrofi otot
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Tanda2 lesi LMN Hipotonus Hiporefleksi/arefleksi Hipotrofi/atrofi otot Fasikulasi (kedutan) R patologis – Clonus -
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Meningeal sign
Kernig’s sign Neck rigidity/Brudzinski 1
Brudzinski 2
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Meningeal sign Brudzinski 3
Penekanan pd os zygomaticus : fleksi pd sendi siku
Brudzinski 4 Penekanan pd simfisis
pubis : fleksi genu + coxae
Guillain Pemijatan pd paha :
fleksi gen
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Iritasi n. ischiadicus
Lasegue O’Connell Gaenslen
Patrick Contra Patrick
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Koordinasi,keseimbangan Romberg Disdiadokhokinesis Dismetri
disdiadokhokinesis
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Fungsi vegetatif Defekasi
Retensi alvi, inkontinensia alvi Miksi
Retensi urin, inkontinensia urin Sexual
Lokal, fungsional
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Sensibility
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Dermatome